AN APPOINTMENT-KEEPING IMPROVEMENT PACKAGE FOR OUTPATIENT PEDIATRICS: SYSTEMATIC REPLICATION AND COMPONENT ANALYSIS

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.     

Path model of multidimensional compliance with cancer therapy

Patients newly diagnosed with hematologic malignancies were followed for a 6-month treatment period to assess compliance with three regimen requirements for cancer therapy: anti-neoplastic medication self-administered intermittently, supportive medication self-administered daily, and monthly clinic appointments. The effect on compliance of three intervention "packages" (some combination of education, shaping of pill-taking behavior, and home restructuring) and the extent that patient satisfaction, knowledge, and uncertainty about illness-related events mediated the effects of the interventions were also examined. Blood levels of the drugs and self-report measures indicated that compliance with daily pill taking was higher for each intervention group compared to a control group. Similar results were obtained for compliance with clinic appointments. No improvement in intermittent self-medication was found. Although each intervention package increased patient knowledge and satisfaction, path analyses demonstrated that knowledge did not affect any aspect of compliance, whereas satisfaction was associated with increased appointment keeping only. Daily pill taking was influenced directly by the behavioral components of the interventions. Uncertainty did not influence compliance but was associated with depression, which was negatively correlated with intermittent self-medication.     

Preliminary evidence on the use of telehealth in an outpatient behavior clinic

Previous studies have shown that telehealth can be an effective way to deliver behavior‐analytic services. In this study, we provided a demonstration of the use of telehealth to assess and initiate treatment of problem behavior in an outpatient clinic. We coached parents of children with autism via telehealth to conduct functional analyses during 1 appointment that lasted 1 hr and subsequently coached them as they implemented functional communication training during 3 subsequent appointments (15 min each). Social functions were identified for most children, and problem behavior was reduced by an average of 65.1%.     

Missed post-hospitalisation clinic appointment in a psychiatric hospital in Southeast Nigeria

ABSTRACT

Patients who have been attended to at psychiatric institutions sometimes fail to keep their scheduled appointments. This study was designed to assess the extent and determinants of missed first clinic appointments among recently discharged patients with schizophrenia. A total of 311 inpatients with a diagnosis of schizophrenia were participated in the study. The diagnosis of schizophrenia was confirmed using Munich version of the Composite International Diagnostic Interview. Socio-demographic and clinical data were collected using the socio-demographic questionnaire while analysis was done using SPSS (version 16). The rate of missed first outpatient appointment was found to be 25.7%. Missed appointment was associated with male gender, state of origin outside the study site, long distance from hospital to place of abode, longer appointment duration and illness severity at discharge. The findings in this study support the need for the introduction of community psychiatric services to improve patient access to services in Nigeria.     

Using Web-Based Technology to Facilitate Client Engagement

To meet the needs of clients, mental health clinics must offer responsive, organized intake procedures. Clients who receive rapid intervention when they request therapy services are more likely to attend and benefit from therapy. The present study examined the effects of implementing a web-based scheduling program on treatment delays and first session attendance. Results indicated that the use of a web-based scheduling system significantly reduced the number of days clients waited for a first appointment and increased the number of kept appointments. Additionally, clients provided with an immediate response to their request for treatment successfully terminated from therapy after fewer sessions.     

Marking Time: The Effect of Timing on Appointment Keeping

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.     

INCREASING APPOINTMENT KEEPING BY REDUCING THE CALL-APPOINTMENT INTERVAL

We examined the effect of reducing the interval between a patient's call for an appointment and the appointment itself. In Experiment 1, patients calling a family planning unit of a public health department were assigned appointments within either 1 or 3 weeks of their call. Data on patient “shows” and “no-shows” were recorded weekly for 6 weeks. Show rates for those in the 1-week appointment group were significantly higher than those in the 3-week group. In Experiment 2, patients were assigned to appointment dates either the next operating clinic day (next-day group) or 2 weeks from the call date (2-week group). Show rates for those in the next-day group were significantly better than show rates for patients in the 2-week group. Clinic productivity, time spent with patients, and consumer satisfaction were also assessed. Implications for appointment scheduling are discussed.     

"When no means no": can reactance augment the theory of planned behavior?

A longitudinal study examined women's clinic attendance for treatment and follow-up after having received an abnormal cervical screening result. Participants (N = 660) completed questionnaire measures of variables specified by the theory of planned behavior and J. Kuhl's (2000) measure of low volitional control--reactance--prior to receiving up to 3 subsequent appointments during the following 15 months. The theory of planned behavior was capable of predicting persistent attendance and discriminated women who kept all of their scheduled appointments from those who dropped out from treatment. Consideration of reactance enhanced prediction of behavior and discriminated between women who delayed appointment keeping and women who ceased attending.     

Psychosocial Functioning in Children and Adolescents with Gastrointestinal Complaints and Disorders

The current study examined the prevalence and presentation of psychosocial symptoms in pediatric patients and their parents presenting for first time appointments at a gastroenterology (GI) clinic compared to healthy controls (HC). One hundred GI patients, aged 8-17 years, and their mothers were compared to 100 age- and gender-matched HC on measures of child and parental behavioral/psychosocial functioning, depression, and anxiety. Results revealed significant correlations between mother- and child-reported internalizing behaviors and psychological symptoms. Significant group differences were observed in internalizing problems, adaptive and social skills, and leadership competency, as well as parental interpersonal sensitivity, depression, phobic anxiety, and number of psychological symptoms. GI patients are at increased risk for psychosocial and social dysfunction compared to healthy peers. Psychosocial factors should be considered when assessing patients in GI clinics. Patients might benefit from treatment plans that involve adjunctive behavioral intervention to assist patients in managing their conditions.     

The impact of waiting-list times on client attendance for relationship counselling

The impact of waiting-list times on subsequent attendance for appointments has received extensive attention within the area of health, but hitherto has received relatively little interest from counselling services. Given the current pressure on all welfare agencies for accountability and efficient use of resources, counselling organisations need to consider resource usage and barriers to efficiency. A study was therefore made of one aspect of this issue: the impact of short v. long time-delays between initial referral and first appointment for relationship counselling. It was found that clients offered appointments within two weeks of referral were significandy more likely to attend for first appointment than were clients whose appointment came between 4 and 12 weeks post-referral. The implications of these results for organisational policy are discussed.     

Impact of Appointment Waiting Time on Attendance Rates at a Clinical Cancer Genetics Service

The increase in demand for clinical cancer genetics services has impacted the ability to provide services timeously. Given limited resources, this often results in extended appointment waiting times. Over the last 3 years, the Cancer Genetics Service at the National Cancer Centre Singapore has continued to experience a steady increase in demand for its service. Nevertheless, significant no-show rates have been reported. This study sought to determine whether an association exists between appointment waiting times and attendance rates. Data was gathered for all participants meeting inclusion criteria. Attendance rates and appointment waiting times were calculated. The relationship between mean waiting times for those who did and did not attend their scheduled appointments was evaluated using Welch’s t test and linear regression model. The results showed a significant difference in mean appointment waiting times between patients who did and did not attend (32.66 versus 43.50 days respectively; p?<?0.0001). Furthermore, patients who waited for longer than 37 days were significantly less likely to attend. No-show rates increased as the waiting time increased, at a rate of 19.60% per 20 days and 21.40% per 30 days. In conclusion, appointment waiting time is a significant predictor for patient attendance. Strategies to ensure patients receive an appointment within the necessary timeframe at the desired setting are important to ensure that individuals at increased cancer risk attend their appointments in order to manage their cancer risks effectively.     

L’animation des collectifs visant la prévention des RPS : étude d’un processus d’intervention en milieu hospitalier

This article presents an intervention process aiming at the prevention of PSRs: diagnosis followed by the development of an action plan produced during three collective meetings. Each meeting is based on a particular type of animation (with reminders focused on causes, with reminders on the solutions and enriched with the psychologist's expertise animations). The stake is to characterise each of these animation methods and to study their impact on the collective activity. The study proceeds in analysis of linguistic production produced. The intervention proceeded in a hospital setting. The development of the action plan implied a collective of 8 to 10 agents who met three times. The results show in particular that (1) style of speech is argumentative whatever either in the form of animation, (2) nature reminders and the issue of the meeting have an impact on the functional structure of the meetings and (3) reminders on the solutions lead the evocation of factual causes so that reminders focused on causes lead to identify more general causes.     

Effectiveness of Pre-counseling Genetic Education Workshops at a Large Urban Community Health Center Serving Low-Income Chinese American Women

Chinese American pregnant women and women of childbearing age face economic, cultural and linguistic barriers in accessing mainstream health care services. The Charles B. Wang Community Health Center developed a culturally and linguistically competent genetic education workshop for high-risk Chinese American prenatal patients. Patients referred for genetic counseling for thalassemia, abnormal triple screen results, and/or advanced maternal age were recruited to participate in the workshop. The workshop provided basic “genetic 101” education, focusing on topics that were directly relevant to the patients’ reasons for referral. The effectiveness of the workshop was measured using a quasi-experimental design with pre-post surveys administered to intervention and control group participants. The evaluation also included a genetic counselor assessment and a pilot study of genetic counseling appointment length. Overall, workshop participants showed significant increases in knowledge, positive attitude and self-efficacy regarding genetic services as compared to their control group counterparts. The pilot appointment length study data revealed that the workshop reduced the length of the genetic counseling appointment time by 40%. These positive findings suggest that it would be worthwhile to replicate the genetic education workshop at other health agencies serving Chinese-speaking populations and that further evaluation research should be conducted.     

The prediction of “shows” and “no-shows” to a crisis center

The relationship between measures of worker effectiveness in a therapeutic telephone intervention and whether a caller shows for a scheduled appointment can be used to assess the variables that contribute to "successful" telephone counseling. This study replicated the findings of a previous investigation in showing that the motivation of a caller in response to the question of a referral was positively correlated with "showing" for the appointment. Futher, the identification of a specific problem related negatively to the caller's response to the referral. However, the concreteness of the phone worker was not correlated with whither the scheduled appointment was kept by the caller.     

Factors Associated with First Session Nonattendance at a University-Based Family Therapy Clinic

Two hundred four consecutive psychotherapy initiators who called for an initial appointment at a university-based family therapy clinic during a one-year period were examined to see what factors influenced nonattendance. Researchers considered factors such as demographics, substance use, medical and psychiatric involvement, clinic practice, and constellation expected to attend. The 118 (58%) initiators who kept their appointment differed significantly from the 86 (42%) who did not in distance to the clinic, partner's age, number of children, marital status, employment, time of appointment, and therapeutic constellation. Divorce, unemployment, having a partner between the ages of 18–24, and having children were significant indicators of nonattendance. An appointment scheduled between 1:00 and 4:59 P.M., seeking conjoint psychotherapy, and living between 6 and 25 miles from the clinic were significant indicators of attendance. Implications for improving initial appointment attendance are presented.     

REDUCING NONCOMPLIANCE TO FOLLOW-UP APPOINTMENT KEEPING AT A FAMILY PRACTICE CENTER

In this study, we evaluated follow-up appointment keeping at a family practice center. To determine if noncompliance could be reduced, four treatments were implemented: no-treatment control, modified appointment card, free follow-up, and a reduced rate follow-up. Thereafter, the reduced rate follow-up was implemented again to determine the extent noncompliance could be reduced for all eligible patients. Incentives significantly increased follow-up appointment keeping, whereas the modified appointment card was ineffective. A cost analysis suggested that the no-treatment control and modified appointment card conditions were the least expensive, but also the least effective. The incentive conditions were more expensive, but the reduced rate condition generated the most net revenue. Questionnaire data suggested that the incentive conditions had an effect on noncompliance and may be considered for use in other medical settings.     

THE USE OF PEER MONITORS TO REDUCE NEGATIVE INTERACTION DURING RECESS

The negative interactions of a mildly retarded child, Dennis, were reduced in three daily recess periods, withthe use of a point system. Adult monitors initiatedthe intervention inthe morning recess; reductions achieved during adult monitoring were maintained in that recess during two subsequent conditions: peer monitoring and self-monitoring. Dennis' negative interactions were reduced next inthe afternoon recess by peer monitors. Again, reductions were maintained during a subsequent self-monitoring condition. Finally, duringthe noon recess, Dennis was trained to serve as a peer monitor for Ed, a moderately retarded classmate. Dennis' rate of negative interactions quickly decreased following his appointment as a peer monitor. The results show that a point system, originally designed for adult monitoring, can be adapted without loss of program effectiveness for peer monitoring or self-monitoring. The results also suggest that classmates who serve as peer monitors may benefit significantly from their role. The conditions under which these therapeutic effects occur andthe role that treatment order effects may play in this process require further investigation.     

Characteristics of Children Presenting to a Behavioral Treatment Program for Pediatric Headache

This study examined headache characteristics and psychological variables associated with pediatric headache in a specialty treatment clinic. Children were referred by pediatric neurologists to a hospital-based pediatric behavioral medicine clinic for behavioral treatment in conjunction with medical management of the pain. Headache typology of the children indicated that 1/3 of the sample reported at least daily headaches, and a large percentage of patients described experiencing headaches that lasted for more than a day (26%). Child and parent report of pain revealed a fairly high level of correspondence for headache activity. Regarding other psychological characteristics, children in this study endorsed higher than expected levels of somatization even after adjusting for headache symptoms. Compared with children's report, parents' report showed only slightly higher levels of secondary gain experienced by children because of pain. Gender differences were not found. The implications of these findings for improving our understanding of pediatric headache are discussed.     

Counseling dropout relative to client attractiveness,disturbance, and expected number of sessions

Participants were 12 counseling center psychologist and thir 257 college-student clients. Immediately after intake, clients indicated whether or not they would make an additional appointment, their reasons for not making another appointment, and the estimated number of sessions they would attend. Counselors rated clients' attractiveness and disturbance and estimated the number of sessions they would have with each client. Clients who did not make a second appointment were generally satisfied with the help they received in one session. Client estimates were more predictive than counselor estimates of actual number of sessions. Relative to less attractive and disturbed clients, more attractive and disturbed clients made and kept post-intake appointments.     

The Effects of Prompts on Minority Children's Screening Attendance at a Community Mental Health Center

This study examined the impact of prompts upon the screening attendence rate at a children's community mental health center (CMHC) serving lower socioeconomic urban minority clients. Subjects (274 children under age 18 and their adult caretakers who contacted the CMHC for screening appointments) were assigned to one of three conditions: (a) a phone prompt one day before the appointment, (b) a letter prompt one to two days before the appointment, and (c) a no-intervention control group. Both phone and letter prompts produced significantly greater attendance than the no-intervention condition. The phone prompt group evidenced a tendency toward greater attendance than the letter prompt group. A cost analysis indicated that the phone prompt generated more net revenue than the other two conditions and had a lower total cost and per subject than the conditon. The data suggest that prompts can be effectively used by mental health facilities to engage minority clients in the intial phase of the treament process.