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OBJECTIVE: To examine the role of executive functioning (EF) in health self-management and the transition to adult health care among college students. PARTICIPANTS: A total of 378 undergraduate students from a public university participated in the study. METHODS: Participants reported on EF, health self-management skills, and their readiness to transition to adult care. Mediation analyses were conducted to evaluate indirect effects of EF on readiness to transition via health self-management skills. RESULTS: Students with greater EF difficulties were less ready to transition to adult care. Specific aspects of health self-management (Medication management/Appointment keeping) mediated the relationship between EF and readiness to transition. CONCLUSION: EF is a key developmental aspect of health self-management and transition readiness. Assessing EF strengths/weaknesses in students with suboptimal health self-management skills may provide valuable information for informing the development of individually-tailored transition plans in university health centers, thereby enhancing developmentally appropriate care during the college years.

We present perspectives of health care providers and clinic staff on the implementation of a financial incentive program for clients living with HIV in three Louisiana clinics. Interviews were conducted in May-June 2015 with 27 clinic staff to assess their perspectives on implementation of the Health Models financial incentive program, which was initiated in September 2013. Many providers and staff welcomed the program, but some were concerned about sustainability and the ethics of a program that paid patients to receive care. Most said they eventually found the program to be helpful for patients and clinic operations in general, by facilitating partnerships between providers and patients, improving appointment keeping, providing opportunities for patient education, engaging patients in care, and helping patients form new prevention habits. The findings can improve understanding of staff and leadership perceptions of incentive programs and can inform planning and implementation of these programs in the future.

Aim of the work To evaluate the effects of early and regular treatment with Disease Modifying Anti-Rheumatic Drugs (DMARDs) on disease outcome in rheumatoid arthritis (RA) patients and factors affecting adherence to treatment. Patients and methods Sixty-four RA patients (83% females, mean age 42.9 ± 11.9 and disease duration 4.5 ± 2 years) were divided into Group A (n = 31) who received DMARDs within 6 months of symptom onset and Group B (n = 33) who received DMARDs later in the disease course. Patients were assessed by the disease activity score DAS28, the Modified Health Assessment Questionnaire-Disability Index (MHAQ-DI), the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-36 and scoring of radiological damage by modified Larsen’s method. Adherence was assessed by self-report and physician judgment. A questionnaire including the most important factors that may affect early and regular treatment by DMARDs/appointment keeping of follow up visits was administered to the patients. Results The adherence rate was 62.5%. Group A patients had significantly lower DAS28, MHAQ-DI, radiological scores (P = 0.001 for all), higher PCS (P = 0.001) and MCS (P = 0.003) scores than group B patients. Among groups A and B, adherent patients had significantly lower DAS28 (P = 0.001 for both) and higher PCS (P = 0.002 and 0.04, respectively) than non-adherent patients. Rural residence, lack of awareness about the disease and lack of belief in medication effectiveness were the most important factors associated with non-adherence (p = 0.04, 0.03 and 0.045, respectively). Conclusion Early treatment and adherence to DMARDs have an important impact on disease outcome in RA patients.

Patient navigator programs (PNP) have been shown to improve colonoscopy completion with demonstrated cost-effectiveness. Despite additional resources available to these patients, many still do not attend their colonoscopies. The aim of this study was to determine factors associated with colonoscopy attendance amongst patients in whom logistical barriers to attendance have been minimized through enrollment in a PNP.Retrospective case-control study of patients enrolled in a PNP for colonoscopy performed at a tertiary endoscopy center from 2009 to 2014. Cases were defined as patients who did not attend their first scheduled colonoscopy after PNP enrollment. Age- and gender-matched controls completed their first scheduled colonoscopy after PNP enrollment.514 subjects (257 cases, mean age 57.1years, 36.6% males) were included. Patients who attended their colonoscopy were less likely to be Spanish-speaking (64.6% vs 78.2%, p=0.0003) and uninsured (0.4% vs 3.9%, p=0.006). Attendance rates were significantly lower for screening colonoscopies compared to an indication of surveillance or diagnostic (45.5% vs 65.3%, p0.0001). Fewer patients attended colonoscopies scheduled on Monday (39.2% vs 52.1%, p=0.04) and in December (10.7% vs 52.3%, p0.0001). On multivariate analysis, poor appointment-keeping behaviors, including a prior missed colonoscopy (OR 0.20, 95% CI 0.10-0.39) or missed office visit (OR 0.44, 95% CI 0.26-0.73) and procedures scheduled on Mondays (OR 0.51, 95% CI 0.27-0.94) were negatively associated with attendance.Appointment-keeping behaviors, in addition to insurance-status, language-barriers and medical comorbidities, influence colonoscopy attendance in a PNP population. Patients scheduled for colonoscopies on Mondays or in December may require more resources to ensure attendance.

Children with cerebral palsy (CP) require ongoing rehabilitation services to address complex health care needs. Attendance at appointments ensures continuity of care and improves health and well-being. The study’s aim was to gain insight into mothers’ perspectives of the factors associated with nonattendance. A qualitative descriptive design was conducted to identify barriers and recommendations for appointment keeping. Semi-structured interviews were conducted with 15 mothers of children with CP. Data underwent inductive qualitative analysis. Mothers provided rich context regarding barriers confronted for appointment keeping—transportation and travel, competing priorities for the child and family, and health services. Mothers’ recommendations for improving the experience of attending appointments included virtual care services, transportation support, multimethod scheduling and appointment reminders, extended service hours, and increased awareness among staff of family barriers to attendance. The results inform services/policy strategies to facilitate appointment keeping, thereby promoting access to ongoing rehabilitation services for children with CP.

Background Rwanda provides free HIV treatment to all HIV positive person. Adolescents and youth have poorer treatment adherence and experience higher treatment failure than adults. This study aimed at exploring the barriers to adherence among adolescents and youth in two district hospitals in rural Rwanda. Methods Adolescents and youth within the age of 10 to 24 years who have been on HIV treatment for at least one year in the two hospitals and their appointment adherence were identified through electronic medical records. Questionnaires were completed by consented participants or their parents and were used to measure treatment adherence in the previous 30 days and in the previous 3 days. In-depth interviews were also conducted to explore the factors associated with poor adherence and outcomes. Results Among the 139 adolescents enrolled for treatment, 58% had good appointment keeping. Out of the 72 questionnaires completed, 87% reported adhering to at least 95% of treatment in the previous 30 days and 47% reported poor adherence in the previous 3 days. Reported factors causing poor adherence included poverty, stigma, and lack of parents. Conclusion The level of adherence to HIV treatment was low among adolescents and youth in rural Rwanda. Creation of projects that can improve social economic status to Adolescent who are on HIV treatment as well as provision of family care to orphanage HIV adolescent patients would improve their treatment adherence. Disclosure No significant relationships.

Patient non-adherence to prescribed anti-epileptic drugs (AEDs) remains a challenge to successful treatment of patients with epilepsy. However, the literature on epilepsy does not document a comprehensive review of interventions to improve adherence as a means to improve clinical outcomes. This study systematically reviews existing literature on interventions to enhance AED adherence and clinical outcomes, and the measures of adherence included in these studies. We selected randomized controlled trials (RCTs) of interventions to enhance adherence with AEDs, which also measured clinical outcomes, with at least 80% follow-up of participants for at least 6 months, from a comprehensive Cochrane review of adherence interventions for medications, complete to January 2013, and updated searches for additional AED studies in multiple bibliographic databases to January 2016. Two review authors independently extracted all data and a third author resolved disagreements. The present update included one trial from the Cochrane review and three RCTs published since, bringing the total number of RCTs on this topic to four. Two types of intervention were tested: educational (e.g., providing information to the patient or carer about treatment characteristics, duration, dosage regime, and how to use the AED) and behavioral (activity in order to remind the patient to take a medicine). Methods of measuring adherence included a combination of direct (plasma AED levels) and indirect measures (prescription refill frequency and appointment keeping) or use alone of self-report adherence on standardized scales. Despite the importance of the problem, evidence is limited concerning enhancement of adherence among people with epilepsy. However, the trials available to date show that medication adherence in epilepsy can be improved, leading to better seizure control.

Purpose The aim of this study was to describe and compare gender differences in adherence and nonadherence to nonpharmacologic recommendations after heart transplant (HTx) globally; in Europe, North America, South America and Australia. Methods This a sub-analysis of self-reported data of 1397 adult HTx recipients from the 36- HTx-center, 11-country, 4-continent, cross- sectional BRIGHT study (ClinicalTrials. gov ID: NCT01608477). The analysis included descriptive statistics. Two-sample t-tests were used to compare the mean gender differences in health behaviors post-HTx, such as sun protection, diet keeping, physical activity, and appointment keeping; and chi-square tests were used to evaluate the relationship between female and male adherence and nonadherence to alcohol use and to smoking. Results Females were more adherent to sun protection in Australia (p=0.03), and in the total of all continents, compared to males (p=0.00). Females were more adherent to 30-minute moderate physical activity 5 days-a-week, in each continent, and in the total of all continents (p-values=0.00, 0.02, 0.04, 0.03, and 0.00 respectively). Complying with 20-minutes of vigorous physical activity 3 days-a-week, females were more adherent in every continent, except for Australia, and in the total of all continents (p-values=0.00, 0.00, 0.00, and 0.00 respectively). Finally, females were more adherent than males in abstaining from smoking in Europe, and in the total of all continents (p=0.01, 009 respectively). Conclusion The findings support the hypothesis that females are, in general, more adherent than males to post-HTx recommendations. This study bridges a gap in the literature, by providing evidence about female and male health behaviors after HTx. This gender-specific information should be used in designing behavioral health gender-specific interventions to improve adherence in transplantation.

Raphael Z Sangeda,1,2 Fausta Mosha,3 Said Aboud,4 Appolinary Kamuhabwa,5 Guerino Chalamilla,6,† Jurgen Vercauteren,2 Eric Van Wijngaerden,7 Eligius F Lyamuya,4 Anne-Mieke Vandamme2,8 1Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, KU Leuven – University of Leuven, Leuven, Belgium; 3Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania; 4Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 5Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 6Management and Development for Health (MDH), Dar es Salaam, Tanzania; 7Department of General Internal Medicine, University Hospitals, KU Leuven – University of Leuven, Belgium; 8Center for Global Health and Tropical Medicine, Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal †Dr Guerino Chalamilla passed away in November 2015 Background: Measurement of adherence to antiretroviral therapy (ART) can serve as a proxy for virologic failure in resource-limited settings. The aim of this study was to determine the factors underlying nonadherence measured by three methods. Patients and methods: This is a prospective longitudinal cohort of 220 patients on ART at Amana Hospital in Dar es Salaam, Tanzania. We measured adherence using a structured questionnaire combining a visual analog scale (VAS) and Swiss HIV Cohort Study Adherence Questionnaire (SHCS-AQ), pharmacy refill, and appointment keeping during four periods over 1 year. Overall adherence was calculated as the mean adherence for all time points over the 1 year of follow-up. At each time point, adherence was defined as achieving a validated cutoff for adherence previously defined for each method. Results: The proportion of overall adherence was 86.4% by VAS, 69% by SHCS-AQ, 79.8% by appointment keeping, and 51.8% by pharmacy refill. Forgetfulness was the major reported reason for patients to skip their medications. In multivariate analysis, significant predictors to good adherence were older age, less alcohol consumption, more advanced World Health Organization clinical staging, and having a lower body mass index with odds ratio (CI): 3.11 (1.55–6.93), 0.24 (0.09–0.62), 1.78 (1.14–2.84), and 0.93 (0.88–0.98), respectively. Conclusion: We found relatively good adherence to ART in this setting. Barriers to adherence include young age and perception of well-being. Keywords: self-report, appointment keeping, pharmacy refill, adherence barriers, resource-limited settings, AIDS

BACKGROUND: The WHO defines adherence as the extent to which a patient's behavior coincides with recommendations from a health-care provider. Nonadherence to cancer treatment has a major impact on the therapeutic outcome. AIM OF THE STUDY: To assess the prevalence of nonadherence to radiation regimen and to analyze the factors that affect adherence to cancer treatment. MATERIALS AND METHODS: Patients receiving radiation treatment in our hospital were screened for adherence to appointment keeping and to the prescribed radiation regimen and patients who had unplanned treatment breaks during treatment were interviewed. Between January and July 2013, we identified 61 patients who had unplanned breaks during treatment. We analyzed the social, emotional, educational, economic, and therapeutic barriers that led to nonadherence. RESULTS: Of the 61 patients who had unplanned breaks during treatment, 54% were males and 46% were females. Fifty-seven percent of patients had head and neck cancers and 25% had gynecological cancers. Seventy-one percent of patients were planned for concurrent chemoradiation. The number of days of unplanned treatment breaks ranged from 3 to 27 days. Social and therapeutic barriers were found to be the most common factor that led to nonadherence in these patients. CONCLUSION: Identification of barriers that lead to nonadherence, designing strategies to overcome such barriers and effective communication becomes imperative to ensure uninterrupted treatment. Based on the above analysis, we have designed several strategies to improve adherence to treatment among our patients.

Appointment-keeping behavior is an important requisite for HCV linkage and treatment initiation. In this study we examine what impact hepatitis C (HCV) knowledge and attitudes has on appointment-keeping behavior among a cohort of HCV and HCV/HIV patients. Knowledge scores and attitude scales, obtained from a cross-sectional survey, were correlated with proportion of appointments kept 1 year prior to taking the survey. Independent risk factors for missing appointments were examined by multiple regression analysis. 292 HCV patients completed the survey, and 149 (51%) were co-infected with HIV. HCV patients kept 67.5 ± 17.4% of their total appointments and a similar proportion (67 ± 38.2) of Liver Clinic appointments, but they attended a higher proportion (73 ± 24.4) of Primary Care Clinic appointments. However, certain health beliefs, psychiatric illness, and HIV co-infection were independently associated with lower levels of appointment-keeping behavior. HCV knowledge was not associated with appointment-keeping behavior. Health beliefs, psychiatric illness, and HIV co-infection are associated with missing appointments, but no link between knowledge and appointment keeping behavior is apparent. In order to increase engagement into HCV care, HCV care coordination programs need to focus on addressing health beliefs and providing resources to those at highest risk for missing appointments.

This study aims to determine the psychosocial correlates of self-reported adherence to cancer treatment appointments and treatment delays and interruptions. The sample included 622 immigrant cancer patients from New York City. Patients completed a survey that included sociodemographic and health-related questions, questions assessing missed appointments and delays/or interruptions, and quality of life and depression scales. After controlling for sociodemographic characteristics, having a positive depression screen and poor physical and emotional well-being were significant predictors of missed appointments and delays and/or interruptions of treatment. Non-adherence to treatment appointments in immigrant cancer patients is a complex outcome related to important modifiable or treatable factors.

Anna Chudiak, Beata Jankowska-Polańska, Izabella Uchmanowicz Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland Background: Frailty syndrome (FS) is an important problem in older persons. It may develop concomitantly to many aging-related diseases, including arterial hypertension, and exerts detrimental effects on both their outcomes and treatment compliance.Objective: To analyze the effect of FS on treatment compliance in older hypertensive patients.Materials and methods: This study of 300 hypertensive patients (167 women and 133 men) aged between 65 and 91years (mean 71.75±7.79years) was based on the analysis of medical documentation and survey with the Tilburg Frailty Indicator (TFI) and Hill-Bone High Blood Pressure Compliance Scale.Results: Mean systolic and diastolic blood pressure values of the study subjects were 141.97 and 85.16mmHg, respectively. Mean time elapsed since the diagnosis of arterial hypertension was 13.74years. FS was diagnosed in 65.67% of the study subjects. Mean global score of the Hill-Bone High Blood Pressure Compliance Scale was 20.75 points. TFI scores correlated significantly with the global score of the Hill-Bone High Blood Pressure Compliance Scale (R=0.509, P

SUMMARY Background and objectives Anecdotal evidence suggests that missed donation appointments among repeat whole-blood donors are associated with decreased likelihood of future blood donation. This study sought to examine the relationship between missed donation appointments and intention to donate again among repeat whole-blood donors and to examine whether demographic variables are related to appointment-keeping behaviour. Methods During the period February–June 2013, telephone interviews were conducted with repeat donors who either did not show up for or cancelled their donation appointments on the day of the appointment. We asked them whether or not they wanted to schedule appointments for subsequent donations. Results Rates of missed donation appointments varied by age, but not gender. Although a statistically significant difference between male and female donors was not found with regard to willingness to donate again, female donors were more likely than male donors to call and cancel their appointment. Finally, compared with repeat donors who called and cancelled their appointment, no-show donors were 2·5 times less likely to schedule appointments for subsequent donations (P

The purpose of this study was to examine the relationships between care demands and caregivers’ medication adherence and health appointment keeping. A cross-sectional correlational design was used to survey a convenience sample of 45 informal caregivers of persons with dementia. Pearson product–moment correlations and hierarchical multiple regressions were used to examine the relationships among study variables. Nearly one third of caregivers reported frequently or occasionally missing medication doses and nearly a half reported not being able to fully keep appointments with health care providers. Female gender, care duration, and care-recipient activities of daily living were significant predictors for medication adherence and appointment keeping. Caregivers’ education and weekly caregiving hours contributed significantly to their medication adherence. Interventions are needed to help caregivers keep health appointments and adhere to their medications.

Two experiments investigated the effects of appointment delay and phone reminders on college students’ appointment-keeping behavior. A significantly higher percentage of students kept their appointments in the 1-day appointment delay condition than in the 15-day delay condition with no reminders in both experiments. Phone reminders provided 1 day prior to the appointment dates increased the percentage of appointments kept in the 15-day delay condition in Experiment 2. In order to assess the shape of the effect of appointment delay, future research should increase the number of values in appointment delay.

Non-adherence to psychiatric and substance abuse treatment recommendations, especially with regard to aftercare outpatient appointment-keeping following hospitalizations, exacts a high cost on mental health spending and prevents patients from receiving therapeutic doses of treatment. Our primary objective was to evaluate the relationship between potential predictors and moderators of aftercare appointment-keeping among a group of adult patients immediately following hospitalization for severe psychiatric disorders or dual diagnosis.Candidate predictors and moderator variables included demographics, psychiatric status, psychiatric symptom severity, and inpatient group adherence, while aftercare appointment-keeping was defined as attendance at the first aftercare appointment. Participants were 121 adult inpatients with a psychiatric disorder or dual diagnosis originally enrolled in an earlier randomized controlled trial comparing standard treatment with standard treatment plus brief motivational interviewing for increasing adherence.RESULTS indicated that, across treatment conditions, those who were female, did not have dual diagnosis, were older (older than 33 years), and were less educated (high school) attended their first aftercare appointment at significantly higher rates than their counterparts. A treatment-by-gender interaction was noted, where only men were significantly more likely to keep their first aftercare appointment if they received standard treatment plus brief motivational interviewing, compared to standard treatment alone (OR = 9.58, p.001).Findings suggest that gender, dual diagnosis status, age and education may be an important predictors of aftercare treatment adherence and that gender may be a moderator of motivational interviewing among individuals with psychiatric disorders or dual diagnosis.

Background: The emergence of HIV drug resistance (HIVDR) is an unavoidable consequence of antiretroviral therapy (ART), and HIVDR early warning indicators (EWIs) could specifically assess factors at individual clinics associated with HIVDR. Thus, the present study aimed to collect data on EWIs for HIV/AIDS at 42 outpatient clinics (OPCs) in 25 northern provinces and cities of Vietnam in 2012. Methods: A retrospective cohort study was conducted. Data was collected from 42 OPCs in 25 northern provinces between October and December 2012. The information was collected retrospectively from outpatient records from 2008 to 2011. Results: In total, 99.8% ART patients were prescribed the correct regimen when starting ART treatment. All facilities met the target of under 20% patients lost to follow-up at 12 months. A total of 31/42 facilities reached the goal for on-time appointment keeping and 37/42 facilities achieved the target of first-line retention after 12-month ARV treatment. Conclusions: EWIs should be performed routinely in HIV/AIDS facilities. The data collected will contribute to monitoring, supervision, periodic assessment, and future plans for HIV/AIDS care and treatment programs in the area.

Neuropsychological follow-up appointments are important for patients who have had intracranial surgery because cognitive deficits are common in this population and prognosis is not always optimistic. Unfortunately some patients cancel or do not show up. The current study attempted to identify predictors of non-attendance in this population. A total of 428 patients recruited over 2 years with a scheduled neuropsychological follow-up appointment after intracranial surgery in the St. Elisabeth Hospital, Tilburg, The Netherlands were included. Demographic, clinical, and other miscellaneous variables were extracted from medical records. Of this total population, 42% were non-attenders. The predictors of non-attendance were as follows: patients who had subdural hematomas and/or malignant tumors (compared to those who had other diagnoses prior to intracranial surgery); those who had been transferred to another hospital (compared to those sent home); those who had been referred for further medical treatment before the appointment; a shorter time interval between discharge and follow-up appointment; and finally, if the patient’s home was further away from the hospital. Patients who undergo intracranial surgery are a very heterogeneous group with different needs. Neuropsychological follow-up after surgery may be important for some patients (the better-functioning and/or those with cognitive complaints) but perhaps not for others (those with more severe prognoses and/or no complaints). We provide suggestions which should increase attendance in those who could benefit from follow-up neuropsychological assessment.

The current study demonstrates the efficacy of using a behavioural contingency contract in conjunction with family-selected reinforcers to increase appointment keeping among low income families in a child and family therapy clinic. Three families with similar presenting problems participated. A multiple baseline across-subjects design with the addition of a reversal component was utilised. Upon treatment implementation, contracts were signed by family members stating that they would receive coupons valuing $30.00 after attending four consecutive clinic appointments. These coupons were selected by the family from a diverse menu. Results indicated increases in appointment keeping following implementation of the behavioural contract. The cost effectiveness of using a behavioural contract in conjunction with economic incentives with low-income families is discussed, and suggestions for future research on appointment keeping are made.

Objective: To examine possible associations between appointment keeping and birth outcome among a sample of low-income high-risk pregnant women enrolled in a prenatal care program. Method: Perinatal outcome measures were evaluated for high-risk program patients who delivered between January 1, 1994 and June 30, 1994. Of these, perinatal outcomes of women who attended thirteen or more clinic appointments (n = 27) were compared to those of women who attended four or fewer appointments (n = 28). Each comparison group comprised roughly 25% of the total group of 119 patients who delivered during this time frame. Results: Program participants who attended the higher number of clinic appointments delivered infants with significantly greater gestational ages and higher birth weights than did the comparison group. Apgar scores averaged higher for participants who attended more visits than for the comparison group. Conclusions: These more favorable birth outcomes support prenatal care services provided to ...

The retrospective memory literature suggests that people develop internal representations of time based on the stable occurrence of events in time. Two experiments were conducted to investigate whether the temporal structure of daily life affects prospective remembering. Fifty-six subjects in Experiment 1 were randomly assigned to an appointment time scheduled either during the ‘work’ week (assumed to be more routine-filled or structured) or the weekend (assumed to be less structured). Results, while non-significant, indicated that the number of reminders may have mediated performance. There was an attempt to control this in Experiment 2. The results indicate that appointments imbedded within more structured days are more easily recalled. © 1997 John Wiley & Sons, Ltd.

The objective of this article was to report on the rate of compliance to medication, sodiumuse and appointment keeping of hypertensive adults who are attending primary healthcare clinics in Tshwane. Despite the availability of effective management of hypertension globally,non-compliance to management still exists. This article reports on the hypertensive adult’s compliance to medication, sodium use and appointment keeping. The design was a crosssectional descriptive study. The sample was n = 101 hypertensive patients from three primary healthcare clinics. Structured interviews were used to gather the data. The results indicated avariation in compliance rate depending on the question asked. When investigating whether the participants received enough medication on their last visit to the clinic, 98% said that they received enough medication to last them a month (Nkosi 2008:130). However, the appointment-keeping scale revealed that 23% of the participants reported that they left the clinic without prescribed medication or missed an appointment. When, using the Hill-Bone Compliance Scale, individuals were asked a question using the verb forgetting, 9 out of 10 would answer ‘no’, but when the verb decide was used to determine compliance, 6 out of 10 would admit to deciding not to take their medication sometimes. In terms of sodium use,33% showed good compliance and 44% low compliance (Nkosi 2008:138). Compliance with regard to taking hypertension medication was 70%, which is good. This study recommends that compliance to hypertension management be assessed by asking questions specifically for sodium use, medication and appointment keeping as it was clear from the findings of this study that a person would comply with appointment keeping but not take medication daily as prescribed or not use sodium as recommended.

A new instrument designed to assess the treatment team's attitudes towards individual families was field tested to assess its correlation with missed appointments. We hypothesized that positive attitudes about families would be associated with high treatment adherence as measured by appointment keeping. The oncologists rated ease of working with parents, estimated appointment adherence and child's degree of illness in 18 children being treated for cancer. The 35 cohabitating parents were assessed for marital discord and parental-estimated appointment adherence. Actual appointment adherence was determined by clinic chart review. Physician-estimated adherence varied systematically with each physician and degree of the patient's morbidity. Factors related to actual adherence include: physician's discomfort in working with parents, father's estimate of home-treatment adherence, with a statistical trend for distance travelled to be inversely related to adherence. Neither marital discord nor parent-estimated adherence was related to appointment adherence. Results are discussed in terms of implications for facilitating adherence.

The feasibility and acceptability of telepsychiatry for low-income Hispanic patients with major depression were assessed.In total, 167 adult Hispanic patients with major depression recruited from a community health center (CHC) were randomly assigned to receive psychiatry services through a video Webcam (WEB) (n=80) or to treatment as usual (TAU) (n=87). The WEB condition consisted of monthly telepsychiatry sessions at the CHC for 6 months provided by one of two Hispanic psychiatrists using an online virtual meeting program. TAU patients received their care from their providers. Acceptability was assessed by comparing appointment keeping for primary care versus telepsychiatry, patients' perceived working alliance with their provider, visit satisfaction, and antidepressant use. Feasibility was assessed using depression outcomes, functional days (unproductive or days lost), and whether WEB and TAU patients differed in their appointment keeping.WEB patients did not differ in the proportion of completed primary care versus telepsychiatry appointments and rated their working alliance with the psychiatrist and their visit satisfaction significantly higher than the TAU patients with their provider. Significantly more WEB than TAU patients used antidepressants. Although depression severity decreased faster among WEB than TAU patients, no differences were found in the overall depression score. WEB and TAU patients did not differ in the number of days that were lost or unproductive due to depression. Although WEB and TAU patients reported being willing to pay for mental health services provided by the CHC, almost proportionately twice as many WEB patients were willing to pay for telepsychiatry.Results show that for low-income depressed Hispanic patients, telepsychiatry service for depression is acceptable, although its feasibility is questionable. The benefits of telemedicine were discussed in terms of improving patient care in ways other than directly providing services to the patients.

Child health-care appointments that are not kept are an important pediatric problem. Previous research has shown that reducing effort (with a parking pass) and reminding patients (with mailed and telephone reminders) significantly improved appointment keeping for first-time and patient-scheduled appointments. This study, using a posttest-only group design, evaluated the effects of various combinations of that intervention applied to clinic-scheduled follow-up appointments. All combinations of the intervention significantly increased cancellations, but none increased appointments kept or decreased appointments not kept significantly. Log linear analyses showed that the lag time between scheduling and the appointment significantly influenced appointment keeping. The results suggest that if clinics want to increase cancellations, a mailed reminder and effort reduction are sufficient. To increase appointment keeping, other interventions, such as reduced lag time, may be necessary.

The purpose of this study was to measure followup appointment-keeping in patients discharged from a General Medicine Inpatient Service and to identify possible predictors of compliance. Patients were interviewed on hospital admission and all charts were reviewed on discharge. A subset of patients were interviewed by telephone an average of one month after first followup appointment date. The study was conducted in an urban public teaching hospital with hospital-based and community clinics. A convenience sample of 209 patients were selected from admissions to the General Medicine Inpatient Service over a three month period. Followup appointment-keeping was recorded on all 195 patients discharged alive. Seventy-five percent of patients had no medical insurance, public or private. A compliance rate of 60% (95% confidence interval: 53% to 67%) with first followup appointment was found. Variables associated with compliance and which retained independence on multiple logistic regression analysis, followed by adjusted odds ratios (95% confidence intervals) were: no copayment requirement, odds ratio 3.2 (1.6 to 6.3), single followup appointment 2.9 (1.4 to 5.9), apartment dwelling 3.2 (1.4 to 7.3) and non-primary care clinic appointment 2.3 (1.1 to 4.8). We conclude that health-care-delivery related factors such as no copayment requirements are strongly associated with appointment-keeping in a public hospital population.

BackgroundInternet portal technologies that provide access to portions of electronic health records have the potential to revolutionize patients’ involvement in their care. However, relatively few descriptions of the demographic characteristics of portal enrollees or of the effects of portal technology on quality outcomes exist. This study examined data from patients who attended one of seven Duke Medicine clinics and who were offered the option of enrolling in and using the Duke Medicine HealthView portal (HVP). The HVP allows patients to manage details of their appointment scheduling and provides automated email appointment reminders in addition to the telephone and mail reminders that all patients receive. ObjectiveOur objective was to test whether portal enrollment with an email reminder functionality is significantly related to decreases in rates of appointment “no-shows,” which are known to impair clinic operational efficiency. MethodsAppointment activity during a 1-year period was examined for all patients attending one of seven Duke Medicine clinics. Patients were categorized as portal enrollees or as nonusers either by their status at time of appointment or at the end of the 1-year period. Demographic characteristics and no-show rates among these groups were compared. A binomial logistic regression model was constructed to measure the adjusted impact of HVP enrollment on no-show rates, given confounding factors. To demonstrate the effect of HVP use over time, monthly no-show rates were calculated for patient appointment keeping and contrasted between preportal and postportal deployment periods. ResultsAcross seven clinics, 58,942 patients, 15.7% (9239/58,942) of whom were portal enrollees, scheduled 198,199 appointments with an overall no-show rate of 9.9% (19,668/198,199). We found that HVP enrollees were significantly more likely to be female, white, and privately insured compared with nonusers. Bivariate no-show rate differences between portal enrollment groups varied widely according to patient- and appointment-level attributes. Large reductions in no-show rates were seen among historically disadvantaged groups: Medicaid holders (OR = 2.04 for nonuser/enrollee, 5.6% difference, P < .001), uninsured patients (OR = 2.60, 12.8% difference, P < .001), and black patients (OR = 2.13, 8.0% difference, P < .001). After fitting a binomial logistic regression model for the outcome of appointment arrival, the adjusted odds of arrival increased 39.0% for portal enrollees relative to nonusers (OR = 1.39, 95% CI 1.22 - 1.57, P < .001). Analysis of monthly no-show rates over 2 years demonstrated that patients who registered for portal access and received three reminders of upcoming appointments (email, phone, and mail) had a 2.0% no-show rate reduction (P < .001), whereas patients who did not enroll and only received traditional phone and mail reminders saw no such reduction (P < .09). ConclusionsMonthly no-show rates across all seven Duke Medicine clinics were significantly reduced among patients who registered for portal use, suggesting that in combination with an email reminder feature, this technology may have an important and beneficial effect on clinic operations.

Identify factors associated with appointment-keeping among HIV-infected adolescents and young adults.HIV-infected adolescent and young adult females in five U.S. cities were followed for a period of 18 months to examine adherence to scheduled clinic visits with their HIV care provider. Psychosocial and behavioral factors that have been shown in other populations to influence appointment adherence were measured at baseline and follow-up visits using an audio computer-assisted self-interview questionnaire. These factors included mood disorder, depressive symptoms, social network support, healthcare satisfaction, disease acceptance, HIV stigma, alcohol use, and marijuana use. CD4 count and prescription of antiretroviral therapy medication were also monitored to understand the influence of health status on appointment- keeping.Participants included 178 youth with a mean age of 20.6 years. Forty-two percent had clinically significant depressive symptoms, 10% had a diagnosable mood disorder, 37% reported marijuana use in the last 90 days, and 47% reported alcohol use. Overall, participants attended 67.3% of their scheduled visits. Controlling for age and health status, marijuana use was the only variable that was associated with appointment-keeping behavior.Considering the importance of appointment-keeping for maintaining personal health and preventing further transmission, screening HIV-infected adolescents for marijuana use could help alert providers of this specific barrier to visit compliance.

Successful control of diabetes mellitus requires lifelong adherence to multiple self-management activities in close collaboration with health professionals. We examined the association of such control with appointment keeping behavior in a rural health system.Among 4,253 predominantly lower socioeconomic status patients with diabetes, the association of metabolic control (most recent A1c7% or9% in two models of respectively 'good' and 'poor' control) with 'missed appointment rate' over a 3-year period was examined using multiple logistic regression.For each 10% increment in missed appointment rate, the odds of good control decreased 1.12x (p0.001) and the odds of poor control increased 1.24x (p0.001). The missed appointment rate was substantially higher among African-American patients (15.9% vs. 9.3% for white patients, p0.001). Controlling for the missed appointment rate and insurance status in multivariate analysis attenuated the racial association with good control, and the racial association with poor control was no longer significant. Older, white patients with health insurance tended to have significantly better metabolic control. There was no independent association of metabolic control with patient income, gender, or number of primary care visits.Adherence to appointments, independent of visit frequency, was a strong predictor of diabetes metabolic control. We hypothesize that missed appointment behavior may serve as an indicator for other diabetes adherence behaviors and associated barriers that serve to undermine successful diabetes self-management.

We evaluated the effects of introducing and discontinuing an intervention designed to improve adherence with scheduled appointments in a pediatric allergy clinic. Five nonadherent and three adherent patients received reminders and incentives for keeping their scheduled appointments. Adherence with appointments increased for three of the five nonadherent children, who had an average increase of 13%, and adherent patients continued to keep appointments during the intervention condition. After 10 scheduled allergy clinic appointments had been kept, incentives were discontinued while reminders continued. Improvements in adherence were not maintained after incentives were discontinued and two children showed reductions in adherence to below-baseline levels. Incentive programs increase appointment keeping, but discontinuing incentives abruptly may result in the return of nonadherence, even when reminders are provided as a maintenance strategy. Future pediatric psychology research and practice should investigate both the benefits and limitations of strategies designed to improve adherence.

Objective Efficient patient–physician collaboration is proven to have a direct benefit on health care outcomes through improved compliance, appointment keeping and use of preventive services. The aim of this study was to evaluate the patient–physician agreement on communication during primary care consultations and consider possible discrepancies. Methods A cross-sectional survey using self-administered questionnaires was performed in primary care in four European countries (Lithuania, Slovenia, Serbia and Russia). Post-consultation evaluations of doctor–patient communication were made by patients and physicians and were compared with pre-consultation expectations of the patient. Discrepancies in these evaluations were determined for the entire database, and within groups of expectations, using factor analysis. Results One thousand three hundred and thirty-two sets of questionnaires were collected by the study team. In this sample, in more than 90% of consultations physicians and patients agreed about meeting patient expectations. Discrepancies were more likely to be identified when the patients were consulting the physician for the first time or had not seen that physician for more than 12 months (up to 26.1%). There is a significantly lower correlation between the physician recognising patient's unmet expectations for all factors if the physician had been working in Primary Care for between 6 and 10 years (8.6%). The results demonstrate that physicians working more than 16 years in practice are less likely to recognise that they have failed to meet the expectations of patients who are seeking reassurance (9%). Conclusion Personal continuity of care is associated with a lower discrepancy between the opinions of patients and physicians regarding meeting patient expectations during consultations in primary care. The highest agreement is within first 6 years in practice, which may reflect long-term effects of training. Practice implications Primary care physicians should put more emphasis on identifying and addressing patient expectations in primary care consultation, including agreement with patient. Existing discrepancies may be considered to be indicators of potential opportunities to improve physician's performance and overall quality of care.

Background The contributions of community health workers (CHWs) in the delivery of culturally relevant programs for hypertension control have been studied since the 1970s. This systematic review examines the effectiveness of CHWs in supporting the care of people with hypertension. Methods Computerized searches were conducted of multiple bibliographic electronic databases from their inception until May 2006. No restrictions were applied for language or study design, and studies were restricted to those that reported at least one outcome among participants. Results Fourteen studies were identified, including eight randomized controlled trials (RCTs). Many of the studies focused on poor, urban African Americans. Significant improvements in controlling blood pressure were reported in seven of the eight RCTs. Several studies reported significant improvements in participants' self-management behaviors, including appointment keeping and adherence to antihypertensive medications. Four studies reported positive changes in healthcare utilization and in systems outcomes. Two of the RCTs showed significant improvements in other patient outcomes, such as changes in heart mass and risk of CVD. Conclusions Community health workers may have an important impact on the self-management of hypertension. Programs involving CHWs as multidisciplinary team members hold promise, particularly for diverse racial/ethnic populations that are under-served.

Introduction: State Medicaid programs were established to care for the poor by eliminating financial barriers that otherwise prevent them from being treated in the mainstream health care system. The number of children eligible for Medicaid services is increasing, yet the number of Medicaid providers remains low. Health care providers cited failed appointments as a major problem with Medicaid patients and a great deterrent to participating. The purpose of this study was to determine whether a difference in appointment-keeping behavior exists between Medicaid and non-Medicaid orthodontic patients. Methods: During a 12-month period, a tally of appointments was kept for all active patients (n = 707) at Virginia Commonwealth University’s Department of Orthodontics. Patients were categorized as either Medicaid or non-Medicaid, and their appointment-keeping behavior was evaluated. Results: A significant difference was found in the number of failed appointments between the groups. The Medicaid patients failed 247 (15.4%) of 1609 appointments, and the non-Medicaid patients failed 367 (8.3%) of 4438 appointments. Medicaid patients accounted for 26.6% of all appointments but were responsible for about 40% of all appointment failures. In addition, 104 (56.2%) of 185 Medicaid patients missed 1 appointment or more during the year, compared with 211 (40.4%) of 522 non-Medicaid patients. Conclusions: The findings from this study support the concern among dental practitioners and orthodontic specialists that Medicaid patients have a higher rate of appointment failures than non-Medicaid patients, although the frequency of missed appointments was substantially lower for orthodontic appointments than that reported for general dental appointments.

Background Missed appointments are a major problem in healthcare delivery, and are one element of patient compliance with treatment. Aim To determine whether there was a relationship between the beliefs, attitudes, expectations of treatment, and previous treatment experiences of acne patients and the keeping of follow-up appointments for treatment. Methods One hundred and forty-four consecutive patients presenting to a private dermatologist's office for the treatment of acne completed questionnaires concerning their beliefs and previous treatment, and a record was maintained of missed appointments over a series of five scheduled appointments. A control group of middle and high school students completed the same pretreatment questionnaire. Six months after starting treatment, a second questionnaire was completed regarding compliance with treatment, problems with medication, and frequency of appointments and appointment keeping. Results There were very few differences between patients and controls in beliefs about the cause and treatment of acne. Patient appointment keeping was as follows: 28% of acne patients attended all four follow-up appointments, 10% three follow-up appointments, 15% two follow-up appointments, 13% one follow-up appointment, and 19% no follow-up appointments. Fifteen per cent of patients dropped out of treatment for one or two appointments and then returned. Conclusions Demographic factors, such as gender, race, method of payment for medical services, and type of therapy prescribed, were more important in determining appointment keeping behavior than were patient attitudes and beliefs, previous therapy, or severity of acne. Although there was no correlation between appointment keeping and knowledge of the condition, knowledge of the medication, severity of acne, age, or previous medical treatment, relationships were observed between demographic factors and appointment keeping.

PURPOSE Literature reviews typically have concluded that personality factors are unrelated to adherence to treatment programs, including adherence to exercise prescribed in cardiac rehabilitation. This study constitutes a reconsideration of this conclusion. Using the California Psychological Inventory (CPI), a well-validated inventory of general personality tendencies, personality variables, and appointment-keeping in cardiac rehabilitation were examined. METHODS Forty-nine men entering a cardiac rehabilitation program completed the CPI. Exercise capacity was measured on entry into the 4-month phase II/III program and at completion. Adherence indicators were appointment-keeping and completion or non-completion of the program. General appointment-keeping and hospital admissions during the subsequent year were tracked. RESULTS Appointment-keeping accounted for 35% of the variance in posttreatment exercise capacity, controlling for pretreatment exercise capacity. Scores on the CPI scales that were significantly related to appointment-keeping were Well-Being (perception of physical/emotional health), Socialization (acceptance of rules and regulations), and Communality (view of self as similar to others). These correlations ranged from 0.49 to 0.38. Those who completed the program (n = 39) had higher scores than those who did not (n = 10) on nearly all of the CPI scales. The differences were significant on the Socialization and Good Impression scales (desire for others to have a favorable impression of oneself). The Socialization score was correlated with keeping appointments in the follow-up year. CONCLUSION Personality variables were associated with appointment-keeping adherence. The consistency of our results with those of other recent studies of personality and adherence is discussed, along with implications for cardiac rehabilitation.

Article Title and Bibliographic Information Appointment keeping behavior of Medicaid vs non-Medicaid orthodontic patients. Horsley BP, Lindauer SJ, Shroff B, Tufekci E, Abubaker AO, Fowler CE, Maxfield BJ. Am J Orthod Dentofacial Orthop 2007;132: 49-53. Level of Evidence Level 3 (Other evidence) Strength of Recommendation Grade Not applicable Purpose/Question To determine if differences exist in the rates of broken appointments between Medicaid and non-Medicaid orthodontic patients. Source Of Funding Medical College of Virginia Orthodontic Education and Research Foundation. Type Of Study/Design Cross-sectional study

To better understand the determinants of adolescents' satisfaction with their health care providers and to examine the relationship among satisfaction, intention to return for follow-up, and appointment-keeping behavior.One hundred and twenty-four adolescent patients attending a university-based general adolescent medicine clinic were surveyed prior to the visit about their attitudes regarding provider behavior. After the visit, subjects completed a questionnaire on provider behavior during the visit, satisfaction with the visit, and intention to keep their follow-up appointment.Multivariate regression analysis revealed that pre-visit attitudes about providers' style of behavior predicted satisfaction (beta = 0.252; p0.01). After controlling for pre-visit attitudes, perceptions about providers' style of behavior proved to be a strong predictor of visit satisfaction (beta = 0.512; p0.01). Visit satisfaction was associated with intention to keep scheduled follow-up appointments (r = 0.327; p0.01). However, subjects with greater intention to return were not more likely to keep their follow-up appointments.Provider behavior is an important determinant of adolescents' satisfaction with their health care.

We examined whether offering an accelerated (same-day) versus a standard (1- to 7-day delay) intake appointment increased initial attendance at an outpatient cocaine treatment program. Significantly more of the subjects who were offered an accelerated intake (59%) attended than those who were given a standard intake (33%), chi 2 (2, N = 78) = 4.198, p < .05. The accelerated intake procedure appears to be useful for enhancing enrollment in outpatient addiction treatment.

A nurse practitioner (NP) program to improve postpartum appointment keeping in an outpatient family planning clinic is described and evaluated. The subjects (N = 59) were non-high-risk obstetric patients prescheduled to be seen at 6 weeks postpartum by the NP. Two groups were identified by convenience sampling: Group A (n = 25), the nonintervention group, and Group B (n = 34), the intervention group. Two types of intervention were used: a postpartum telephone call after discharge (n = 11), or a predischarge postpartum visit (n = 23). Results suggest that those in the intervention group were more likely to keep their appointments (p less than .02); only the postpartum visit increased the probability of appointment keeping (p less than .05).