Patient-Reported Attributions for Missed Colonoscopy Appointments in Two Large Healthcare Systems
Patient-Reported Attributions for Missed Colonoscopy Appointments in Two Large Healthcare Systems
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DOI：
10.1007/s10620-016-4096-3
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发表时间：
2016-07-01
影响因子：
3.1
通讯作者：
Singh, Hardeep
中科院分区：
文献类型：
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作者：
Bhise, Viraj;Modi, Varsha;Singh, Hardeep
错过结肠镜检查预约（未显示）可能导致浪费资源和延误结直肠癌诊断，这是公共卫生系统特别关注的一个领域，通常为弱势患者提供护理。我们的目标是确定在休斯敦，得克萨斯州的两个大型公共卫生系统寻求护理的患者错过结肠镜检查预约的原因。我们进行了一项电话调查，在两个三级医疗卫生系统错过结肠镜检查预约的患者。使用结构化的调查工具，我们收集的信息，病人的具体和卫生服务的障碍。患者特异性障碍包括感知到的程序相关因素（例如，准备困难），认知-情感因素（例如，对谦虚的恐惧或担忧），以及健康状况的变化（例如，健康状况改善或恶化）。卫生服务障碍包括后勤因素（例如，与旅行有关的困难）和预约安排问题（不方便的日期或时间）。我们检查了两个研究中心之间错过预约归因的差异。在研究期间错过预约的160名独特患者（102名研究中心A和58名研究中心B）中，153名（95.6%）将其未出现归因于至少一个列出的障碍。大多数受访者（125人; 78.1%）将旅行相关问题或日程安排问题列为错过约会的原因。没有车或旅伴是最常见的旅行相关问题。我们还发现两个地点之间的障碍有显著差异，大多数错过结肠镜检查预约是由于潜在的可预防的旅行和旅行相关问题。由于保持结肠镜检查预约的障碍在卫生系统中是不同的，每个卫生系统可能需要制定独特的干预措施，以减少错过结肠镜检查预约。
Missed colonoscopy appointments (no-shows) can lead to wasted resources and delays in colorectal cancer diagnosis, an area of special concern in public health systems that often provide care for vulnerable patients. Our objective was to identify reasons for missed colonoscopy appointments in patients seeking care at two large public health systems in Houston, TX.We conducted a telephone survey of patients who missed their colonoscopy appointments at two tertiary care health systems. Using a structured survey instrument, we collected information on patient-specific and health services barriers. Patient-specific barriers included perceived procedural-related factors (e.g., difficulty in preparation), cognitive-emotional factors (e.g., fear or concern about modesty), and changes in health status (e.g., improvement or worsening of health). Health services barriers included logistical factors (e.g., travel-related difficulties) and appointment scheduling problems (inconvenient date or time). We examined differences in attributions for missed appointments between the two study sites.Of 160 unique patients (102 Site A and 58 Site B) who missed their appointment during the study period, 153 (95.6 %) attributed their no-show to at least one of the listed barriers. Most respondents (125; 78.1 %) cited travel-related issues or scheduling problems as reasons for their missed appointment. Not having a ride or a travel companion was the most commonly reported travel-related issue. We also found significant differences for barriers between the two sites.Most missed colonoscopy appointments resulted from potentially preventable travel- and scheduling-related issues. Because barriers to keeping colonoscopy appointments are different across health systems, each health system might need to develop unique interventions to reduce missed colonoscopy appointments.