Patterns and patient factors associated with loss to follow-up in the Muhimbili sickle cell cohort, Tanzania.
Patterns and patient factors associated with loss to follow-up in the Muhimbili sickle cell cohort, Tanzania.
复制标题
DOI：
10.1186/s12913-020-05998-6
复制
发表时间：
2020-12-14
影响因子：
2.8
通讯作者：
Makani J
中科院分区：
文献类型：
--
作者：
Masamu U;Sangeda RZ;Kandonga D;Ondengo J;Ndobho F;Mmbando B;Nkya S;Msami K;Makani J
监测病人的临床护理是改善护理和治疗方案保留率的重要手段。镰状细胞病患者的结果通过参与综合护理方案得到改善，但如果患者从临床护理中消失，这些益处就无法实现。在这项研究中，患者被定义为失访，当他们没有参加诊所超过9个月。需要关于那些不遵守诊所预约的人的留存率和特征的准确信息，以便能够实施有效提高护理留存率的干预措施。这是一项回顾性研究，涉及坦桑尼亚Muhimbili镰状细胞队列中登记的镰状细胞患者。采用非参数方法（Kaplan-Meier估计量和对数秩检验）和半参数方法（考克斯比例风险模型）进行描述性和生存分析。认为p值0.05具有显著性，可从分析中进行推断。2004年至2016年，该队列共登记了5476例患者。其中，3350例（58.13%）积极参加门诊，2126例（41.87%）不活动，其中1927例（35.19%）失访。我们使用2004年至2014年的数据，因为在2015年至2016年期间，患者被转介到其他政府医院。从生存分析结果来看，儿童（HR：14.29，95%CI：11.0071-18.5768，p < 0.001）和5 - 17岁儿童[HR：2.61，95%CI：2.2324-3.0705，p < 0.001]患者失访的可能性高于成人（18岁及以上）患者。结果发现，红细胞压积（HR：2.38，95% CI：1.0076-1.0404，p = 0.0039）或平均细胞体积（HR：4.28，（95% CI：1.0260-1.0598，p < 0.001）高于平均值的患者比其对应者更有可能失访。失访在接受长期综合护理的患者队列中很明显。因此，有必要设计干预措施，改善患者的保留。建议的解决方案包括对卫生保健工作者和负责患者随访的人员进行复习培训，以掌握留住患者的技术，并制定全面的过渡计划，为从儿科诊所转到成人诊所的患者做好准备。
Monitoring patient’s clinical attendance is a crucial means of improving retention in care and treatment programmes. Sickle cell patients’ outcomes are improved by participation in comprehensive care programmes, but these benefits cannot be achieved when patients are lost from clinical care. In this study, patients are defined as loss to follow-up when they did not attend clinic for more than 9 months. Precise information on the retention rate and characteristics of those who are not following their clinic appointments is needed to enable the implementation of interventions that will be effective in increasing the retention to care. This was a retrospective study involving sickle cell patients registered in the Muhimbili Sickle Cohort in Tanzania. Descriptive and survival analysis techniques both non-parametric methods (Kaplan-Meier estimator and Log-rank test) and semi-parametric method (Cox’s proportional hazard model), were used. A p-value of 0.05 was considered significant to make an inference from the analysis. A total of 5476 patients were registered in the cohort from 2004 to 2016. Of these, 3350 (58.13%) were actively participating in clinics, while 2126 (41.87%) were inactive, of which 1927 (35.19%) were loss to follow-up. We used data from 2004 to 2014 because between 2015 and 2016, patients were referred to other government hospitals. From the survival analysis results, pediatric (HR: 14.29,95% CI: 11.0071–18.5768, p < 0.001) and children between 5 and 17 years [HR:2.61,95% CI:2.2324–3.0705, p < 0.001] patients were more likely to be loss to follow-up than the adult (18 and above years) patients. It was found that patients with above averages for hematocrit (HR: 2.38, 95% CI: 1.0076–1.0404, p = 0.0039) or mean cell volume (HR: 4.28, (95% CI: 1.0260–1.0598, p < 0.001) were more likely to be loss to follow-up than their counterparts. Loss to follow-up is evident in the cohort of patients in long term comprehensive care. It is, therefore, necessary to design interventions that improve patients’ retention. Suggested solutions include refresher training for health care workers and those responsible for patient follow-up on techniques for retaining patients and comprehensive transition programs to prepare patients who are moving from pediatric to adult clinics.
登录
查看更多内容
影响因子：
0.9
作者：
Rao SS;Goyal JP;Raghunath SV;Shah VB
通讯作者：
Shah VB
影响因子：
3.2
作者：
McPherson, Marianne;Thaniel, Lisa;Minniti, Caterina P.
通讯作者：
Minniti, Caterina P.
影响因子：
--
作者：
Makani, Julie;Tluway, Furahini;Mmbando, Bruno P
通讯作者：
Mmbando, Bruno P
影响因子：
4
作者：
Makubi, Abel;Sasi, Philip;Makani, Julie
通讯作者：
Makani, Julie
影响因子：
3.2
作者：
Allemang, Brooke;Allan, Kate;Kuo, Kevin H. M.
通讯作者：
Kuo, Kevin H. M.