Clinic nonattendance is associated with increased emergency department visits in adults with congenital heart disease

Awh, Katherine; Venuti, Morgan A.; Gleason, Lacey P.; Rogers, Rachel; Denduluri, Srinivas; Kim, Yuli Y.

doi:10.1111/chd.12784

Cited by 15 publications

(6 citation statements)

References 33 publications

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“…Sporadic or recurrent nonattendance was unrelated to sex, age, diagnosis, ACHD AP group or socioeconomic group ( Table S1 ). Unlike others, we found no relationship between clinic nonattendance and emergency hospital admissions [ 16 ].…”

Section: Resultscontrasting

confidence: 99%

Ambulatory Care in Adult Congenital Heart Disease—Time for Change?

Coats

Chaudhry

2022

JCM

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Background: The adult congenital heart disease (ACHD) population is growing in size and complexity. This study evaluates whether present ambulatory care adequately detects problems and considers costs. Methods: A UK single-centre study of clinic attendances amongst 100 ACHD patients (40.4 years, median ACHD AP class 2B) between 2014 and 2019 and the COVID-19 restrictions period (March 2020–July 2021). Results: Between 2014 and 2019, there were 575 appointments. Nonattendance was 10%; 15 patients recurrently nonattended. Eighty percent of appointments resulted in no decision other than continued review. Electrocardiograms and echocardiograms were frequent, but new findings were rare (5.1%, 4.0%). Decision-making was more common with the higher ACHD AP class and symptoms. Emergency admissions (n = 40) exceeded elective (n = 25), with over half following unremarkable clinic appointments. Distance travelled to the ACHD clinic was 14.9 km (1.6–265), resulting in 433–564 workdays lost. During COVID 19, there were 127 appointments (56% in-person, 41% telephone and 5% video). Decisions were made at 37% in-person and 19% virtual consultations. Nonattendance was 3.9%; there were eight emergency admissions. Conclusion: The main purpose of the ACHD clinic is surveillance. Presently, the clinic does not sufficiently predict or prevent emergency hospital admissions and is costly to patient and provider. COVID-19 has enforced different methods for delivering care that require further evaluation.

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Section: Resultscontrasting

confidence: 99%

Ambulatory Care in Adult Congenital Heart Disease—Time for Change?

Coats

Chaudhry

2022

JCM

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“…A number of studies have reported no-show rates ranging from 4% to 80% in multiple clinical areas, including family medicine [ 39 – 41 ], general medicine [ 42 ], pediatrics [ 43 ], dermatology [ 44 , 45 ], cardiology [ 21 , 46 ], neurology [ 21 , 47 ], radiology [ 48 , 49 ], gastroenterology [ 50 , 51 ], ophthalmology [ 21 , 52 ], endocrinology [ 21 , 53 ], orthopedics [ 21 ], otolaryngology [ 21 , 54 , 55 ], plastic surgery [ 21 , 56 ], pulmonary [ 21 , 57 ], psychiatry [ 58 ], allergy [ 21 , 57 ], oncology [ 59 ], rheumatology [ 21 ], urogynecology [ 60 ], and urology [ 18 , 21 , 61 ]. The median prevalence of no-shows is lower in adult and pediatric primary care settings (< 20%) and higher in specialty care such as cardiology (30%), endocrinology (36%) and physiotherapy/physical therapy (57%).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of no-shows to physical therapy for musculoskeletal conditions

et al. 2021

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Objectives Chronic pain affects 50 million Americans and is often treated with non-pharmacologic approaches like physical therapy. Developing a no-show prediction model for individuals seeking physical therapy care for musculoskeletal conditions has several benefits including enhancement of workforce efficiency without growing the existing provider pool, delivering guideline adherent care, and identifying those that may benefit from telehealth. The objective of this paper was to quantify the national prevalence of no-shows for patients seeking physical therapy care and to identify individual and organizational factors predicting whether a patient will be a no-show when seeking physical therapy care. Design Retrospective cohort study. Setting Commercial provider of physical therapy within the United States with 828 clinics across 26 states. Participants Adolescent and adult patients (age cutoffs: 14–117 years) seeking non-pharmacological treatment for musculoskeletal conditions from January 1, 2016, to December 31, 2017 (n = 542,685). Exclusion criteria were a primary complaint not considered an MSK condition or improbable values for height, weight, or body mass index values. The study included 444,995 individuals. Primary and secondary outcome measures Prevalence of no-shows for musculoskeletal conditions and predictors of patient no-show. Results In our population, 73% missed at least 1 appointment for a given physical therapy care episode. Our model had moderate discrimination for no-shows (c-statistic:0.72, all appointments; 0.73, first 7 appointments) and was well calibrated, with predicted and observed no-shows in good agreement. Variables predicting higher no-show rates included insurance type; smoking-status; higher BMI; and more prior cancellations, time between visit and scheduling date, and between current and previous visit. Conclusions The high prevalence of no-shows when seeking care for musculoskeletal conditions from physical therapists highlights an inefficiency that, unaddressed, could limit delivery of guideline-adherent care that advocates for earlier use of non-pharmacological treatments for musculoskeletal conditions and result in missed opportunities for using telehealth to deliver physical therapy.

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“…In addition, the increasing frequency of acquired diseases such as diabetes or arterial hypertension also need strict pharmacological and non-pharmacological treatment (10)(11)(12). In general, in congenital heart disease medication non-adherence, as well as non-adherence to other therapeutic recommendations is associated with adverse outcome (13)(14)(15)(16). Adherence to medication has already been examined in chronic diseases and cardiac diseases other than congenital heart disease.…”

Section: Introductionmentioning

confidence: 99%

Factors That Influence Adherence to Medication in Adults With Congenital Heart Disease (ACHD)

et al. 2021

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Objective: Innovative operative and interventional procedures have improved survival in congenital heart disease (CHD), and today more than 90% of these children reach adulthood. Consequently, adherence and psychosocial issues are becoming increasingly important because non-adherence to treatment recommendations worsens morbidity and mortality. This study aimed to identify factors modifying adherence to medication in adult congenital heart disease (ACHD).Methods: This cross-sectional study included 451 outpatients (female 47.9%, average age ± SD: 37.9 ± 12 years) from the ACHD department, who completed a questionnaire assessing medication non-adherence and individual barriers to treatment. Further assessments included psychological well-being (Hospital Anxiety and Depression scale; HADS), childhood traumatization, sociodemographic, and clinical data. Binary logistic regression analysis calculated the impact of these factors on drug adherence.Results: Of the 451 patients 162 participants (35.9%) reported to be non-adherent. In univariate analysis non-adherence to treatment was associated with smoking (P = < 0.001) and internet addiction (P = 0.005). Further factors negatively influencing adherence were the presence of depressive symptoms (P = 0.002), anxiety (P = 0.004), and childhood traumatization (p = 0.002). Factors positively associated with adherence were older age (P = 0.003) and more advanced heart disease as indicated by NYHA class (P = 0.01), elevated NT-proBNP (P = 0.02), device therapy (P = 0.002) and intermittent arrhythmias (P = 0.01). In multivariate analysis especially psychopathological factors such as depression (P = 0.009), anxiety (P = 0.032) and childhood traumatization (P = 0.006) predicted non-adherence.Conclusion: Adherence is a critical issue in the long-term management of ACHD. Identifying modifiable factors that worsen adherence offers the opportunity for targeted interventions. Depressive symptoms, anxiety, and adverse childhood experiences are amenable to psychosocial interventions, as well as cigarette smoking. Our study suggests that a multimodal and interdisciplinary treatment concept for the long-term management of adults with congenital heart disease could be beneficial. Whether it will further improve morbidity and mortality, should be assessed in prospective interventions.

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Clinic nonattendance is associated with increased emergency department visits in adults with congenital heart disease

Cited by 15 publications

References 33 publications

Ambulatory Care in Adult Congenital Heart Disease—Time for Change?

Ambulatory Care in Adult Congenital Heart Disease—Time for Change?

Prevalence and predictors of no-shows to physical therapy for musculoskeletal conditions

Factors That Influence Adherence to Medication in Adults With Congenital Heart Disease (ACHD)

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