Use of Ambulatory Medical Care by the Poor: Another Look at Equity

Kleinman, Joel C.; Gold, Marsha; Makuc, Diane M.

doi:10.1097/00005650-198110000-00004

Cited by 100 publications

(46 citation statements)

References 6 publications

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“…Research in this area suggests that clinic attendance is dependent on the condition being treated, the age of the patient, and various other social and psychological factors. 1,3,17 Adolescents as well as adults and children of lower socioeconomic status (SES), independent of race and ethnic group, are more likely to miss medical appointments. 3,18,19 Adolescents may delay or fail to seek medical care until their symptoms are severe or incapacitating.…”

Section: Commentmentioning

confidence: 99%

“…3 Adolescents' compliance with medical and dental regimens may be related to factors such as self-esteem and health locus of control. 17,20 According to the Health Belief Model, adolescent compliance with health care advice is more likely among those who feel susceptible to a health problem that they perceive as serious, and also among those who feel that their adherence to medical or dental recommendations is likely to have beneficial effects. 17,20,21 Several interventional studies in large pediatric practices, generally among lower SES populations, have demonstrated the effectiveness of both telephone and mailed reminders in reducing the number of broken appointments.…”

Section: Commentmentioning

confidence: 99%

“…17,20 According to the Health Belief Model, adolescent compliance with health care advice is more likely among those who feel susceptible to a health problem that they perceive as serious, and also among those who feel that their adherence to medical or dental recommendations is likely to have beneficial effects. 17,20,21 Several interventional studies in large pediatric practices, generally among lower SES populations, have demonstrated the effectiveness of both telephone and mailed reminders in reducing the number of broken appointments. 9 -12 In a large study of children with patient demographics and practice techniques similar to those in many private practices, Quattlebaum and colleagues 13 achieved an ϳ48% improvement in both well-child and sick visits by means of computer-generated postcard reminders.…”

Section: Commentmentioning

confidence: 99%

“…4 The only study that tested the effect of reminders on appointment compliance exclusively among adolescents involved dental rather than medical appointments, and the results of that study found that compliance was not improved significantly by mailed appointment reminders. 17 There are several issues to consider when interpreting the results of this study. Perhaps the type of visit (urgent, routine physical examination, followup), not measured in this study, may have been a potentially confounding variable if it had been associated with both attendance and the study intervention.…”

Section: Commentmentioning

confidence: 99%

“…The only study that tested the effect of reminders on appointment compliance among adolescents involved dental rather than medical appointments, and the results of that study concluded that compliance was not improved significantly by mailed appointment reminders. 17 The purpose of this study was to examine the effect of a single telephone call reminder on appointment compliance among adolescents in an inner city, hospital-based clinic. …”

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confidence: 99%

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Telephone Call Reminders and Attendance in an Adolescent Clinic

O'Brien

Lazebnik

1998

Pediatrics

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ABSTRACT. Objective. To determine the effect of a single telephone call reminder on appointment compliance among adolescents in an inner city, hospital-based clinic.Methods. A randomized clinical trial was conducted at the Adolescent Clinic, a part of the Ambulatory Pediatric Practice Clinic in Cleveland, Ohio, from December 1995 to November 1996. A total of 703 routine adolescent ambulatory appointments were randomized to receive either a single telephone call reminder 1 day before the appointment or to receive no reminder. A single telephone call attempt was directed primarily to the parent or guardian of the patient in the assignment group. If not available, the reminder message was left with the patient or other family member, or on the answering machine. The study variables selected included age, gender, appointment time, distance from clinic, and payment source, and for the intervention group, the recipient of the reminder telephone call. The outcome measure was the attendance rate.Results. The intervention group (n ‫؍‬ 347) and control group (n ‫؍‬ 356) were well balanced for all study variables. The overall attendance rate was 49.8%. Only 204 (58.8%) of the 347 attempted intervention appointments were contacted successfully by telephone. In the attempted intervention analysis, the attendance rate of 55.6% in the intervention group (n ‫؍‬ 347), regardless of whether subjects were successfully contacted by telephone, was 26.1% greater than the 44.1% attendance rate in the control group. In the completed intervention analysis, the attendance rate of 65.2% in the successfully contacted individuals within the intervention group (n ‫؍‬ 204) was increased by 47.8% over that in the control group. In the univariate analysis, attendance for selfpaying patients (25.4%) was worse than that for any group. In the logistic regression analysis, both the reminder telephone call intervention and the payment source were independent predictors of attendance. In the group that was called successfully (n ‫؍‬ 204), there was no association between attendance and the recipient of the telephone call.Conclusions. Telephone reminders are a very effective method of increasing attendance in a hospital-based adolescent clinic. The reminder is a consistently effective intervention whether the message is delivered to the patient, to the parent or other family member, or to a telephone answering machine. Adolescent patients whose visits are not covered by Medicaid or commercial insurance are least likely to attend their clinic appointments, and a telephone call reminder has no effect on this pattern. Pediatrics 1998;101(6). URL: http://www. pediatrics.org/cgi/content/full/101/6/e6; adolescents, appointment compliance, telephone reminder.ABBREVIATIONS. CI, confidence interval; OR, odds ratio; RR, rate ratio; SES, socioeconomic status.A major limitation in health care delivery to adolescents is their poor attendance at ambulatory clinics. The failed appointment rate in this age group can be as high as 60%.1-6 A recent large national surve...

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Section: Commentmentioning

confidence: 99%