Lost to Follow-Up But Perhaps Not Lost in the Health System

2012 ◽  
Vol 61 (5) ◽  
pp. e75-e77 ◽  
Author(s):  
Chris Delcher ◽  
Genevive Meredith ◽  
Mark Griswold ◽  
Barbara Roussel ◽  
Nirva Duval ◽  
...  
Keyword(s):  
Health System ◽  
Lost To Follow Up

scholarly journals Understanding pretreatment loss to follow-up of tuberculosis patients: an explanatory qualitative study in Chennai, India

2020 ◽  
Vol 5 (2) ◽  
pp. e001974 ◽  
Author(s):  
Beena E Thomas ◽  
Chandra Suresh ◽  
J Lavanya ◽  
Mika M Lindsley ◽  
Amith T Galivanche ◽  
...  
Keyword(s):  
Health System ◽  
Healthcare Worker ◽  
Qualitative Interviews ◽  
Explanatory Model ◽  
Group Discussions ◽  
Loss To Follow Up ◽  
Sputum Microscopy ◽  
Worker Absenteeism ◽  
Lost To Follow Up

IntroductionPretreatment loss to follow-up (PTLFU)—dropout of patients after diagnosis but before treatment registration—is a major gap in tuberculosis (TB) care in India and globally. Patient and healthcare worker (HCW) perspectives are critical for developing interventions to reduce PTLFU.MethodsWe tracked smear-positive TB patients diagnosed via sputum microscopy from 22 diagnostic centres in Chennai, one of India’s largest cities. Patients who did not start therapy within 14 days, or who died or were lost to follow-up before official treatment registration, were classified as PTLFU cases. We conducted qualitative interviews with trackable patients, or family members of patients who had died. We conducted focus group discussions (FGDs) with HCWs involved in TB care. Interview and FGD transcripts were coded and analysed with Dedoose software to identify key themes. We created categories into which themes clustered and identified relationships among thematic categories to develop an explanatory model for PTLFU.ResultsWe conducted six FGDs comprising 53 HCWs and 33 individual patient or family member interviews. Themes clustered into five categories. Examining relationships among categories revealed two pathways leading to PTLFU as part of an explanatory model. In the first pathway, administrative and organisational health system barriers—including the complexity of navigating the system, healthcare worker absenteeism and infrastructure failures—resulted in patients feeling frustration or resignation, leading to disengagement from care. In turn, HCWs faced work constraints that contributed to many of these health system barriers for patients. In the second pathway, negative HCW attitudes and behaviours contributed to patients distrusting the health system, resulting in refusal of care.ConclusionHealth system barriers contribute to PTLFU directly and by amplifying patient-related challenges to engaging in care. Interventions should focus on removing administrative hurdles patients face in the health system, improving quality of the HCW-patient interaction and alleviating constraints preventing HCWs from providing patient-centred care.

scholarly journals Healthcare Navigation of Black and White Adolescents Following Sport-Related Concussion: A Path Towards Achieving Health Equity

2021 ◽  
Author(s):  
Jessica Wallace ◽  
Brian Q. Hou ◽  
Katherine Hajdu ◽  
Alan R. Tang ◽  
Alan Z. Grusky ◽  
...  
Keyword(s):  
Health System ◽  
Racial Differences ◽  
Care Pathway ◽  
Athletic Trainer ◽  
School Type ◽  
Adolescent Athletes ◽  
Black And White ◽  
White Athletes ◽  
Lost To Follow Up

Abstract Context: Care-seeking behaviors for sport-related concussion (SRC) are not consistent across demographic subgroups. These differences may not only stem from health inequities but can further perpetuate disparities in care for SRCs. Objective: To determine whether racial differences exist in the care pathway from injury to SRC clinic within adolescent athletes. Design: Retrospective cohort Setting: Regional SRC center Participants: Of 582 total athletes, 486 (83.5%) White and 96 (16.5%) Black adolescent athletes were diagnosed with SRC and evaluated within 3 months at the SRC clinic. Main Outcome Measures: Race was the defined exposure, dichotomized as Black or White. The four primary outcomes included: 1)location of first health system contact, 2)time from injury to first health system contact 3) time to in-person SRC clinic visit, and 4) whether the athlete established care (>1 visit), was released immediately to an athletic trainer, or lost to follow-up. Results: Black and White athletes mostly presented directly to SRC clinic (61.5% vs 62.3%) at a median[interquartile range] of 3[1,5] vs 4[1,8] days respectively (p=0.821). Similar proportions of Black and White athletes also first presented to the ED (30.2% vs 27.2%) at a median of 0[0,1] vs 0[0,1] days (p=0.941). Black athletes more frequently had care transferred to their athletic trainer (39.6% vs 29.6%) and less frequently established care (56.3% vs 64.0%), however these differences were not statistically significant (p=0.138). Lost to follow-up was uncommon among Black and White athletes alike (4.2% vs 6.4%). Conclusions: This study demonstrated that within an established SRC referral network and multidisciplinary clinic, there were no observed racial disparities in how athletes were initially managed and/or ultimately presented to SRC clinic despite racial differences in school type and insurance coverage. SRC center assimilation and affiliation with school systems may be helpful in improving access and providing equitable care across diverse patient demographics.

Lost to Follow-Up

2009 ◽  
Vol 40 (12) ◽  
pp. 13
Author(s):  
ALAN ROCKOFF
Keyword(s):  
Lost To Follow Up

Predicting the risk of becoming lost to follow-up in a lifestyle weight-loss intervention

2013 ◽  
Author(s):  
Danielle M. Lespinasse ◽  
Kristen E. Medina ◽  
Stacey N. Maurer ◽  
Samantha A. Minski ◽  
Renee T. Degener ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Loss Intervention ◽  
Lost To Follow Up

1174-P: Reducing Lost to Follow-Up Rates in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1174-P
Author(s):  
RYAN MCDONOUGH ◽  
SARAH THOMAS ◽  
NICOLE RIOLES ◽  
OSAGIE EBEKOZIEN ◽  
MARK A. CLEMENTS ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Collaborative ◽  
Lost To Follow Up

Effects and utility of an online forward triage tool during the SARS-CoV-2 pandemic: patient perspectives (Preprint)

2020 ◽  
Author(s):  
Janet Michel
Keyword(s):  
Decision Making ◽  
Health System ◽  
Information Source ◽  
Patient Perspectives ◽  
User Friendliness ◽  
Fear And Anxiety ◽  
Mail Address ◽  
Second Wave ◽  
E Mail

BACKGROUND Background: Online forward triage tools (OFTT) or symptom checkers are being widely used during this COVID-19 pandemic. The effects and utility of such tools however, have not been widely assessed. OBJECTIVE Objective: To assess the effects (quantitatively) and the utility (qualitatively) of a COVID-19 OFTT in a pandemic context, exploring patient perspectives as well as eliciting recommendations for tool improvement. METHODS Methods: We employed a mixed-method sequential explanatory study design. Quantitative data of all users of the OFTT between March 2nd, 2020 and May 12th, 2020 were collected. A follow-up survey of people who consented to participation was conducted. Secondly, qualitative data was collected through key informant interviews (n=19) to explain the quantitative findings, as well as explore tool utility, user experience and elicit recommendations. RESULTS Results: An estimate of the effects, (quantitatively) and the utility (qualitatively) of a COVID-19 OFTT in a pandemic context, and recommendations for tool improvement. In the study period, 6,272 users consulted our OFTT; 560 participants consented to a follow-up survey and provided a valid e-mail address. 176 (31.4%) participants returned a complete follow-up questionnaire. 85.2% followed the recommendations given. 41.5% reported that their fear was allayed after using tool and 41.1% would have contacted the GP or visited a hospital had the tool not existed. Qualitatively, seven overarching themes emerged namely i) accessibility of tool, ii) user-friendliness of tool, iii) utility of tool as an information source, iv) utility of tool in allaying fear and anxiety, v) utility of tool in decision making (test or not to test), vi) utility of tool in reducing the potential for onward transmissions (preventing cross infection) and vii) utility of tool in reducing health system burden. CONCLUSIONS Conclusion: Our findings demonstrated that a COVID-19 OFTT does not only reduce the health system burden, but can also serve as an information source, reduce anxiety and fear, reduce cross infections and facilitate decision making (to test or not to test). Further studies are needed to assess the transferability of these COVID-19 OFTT findings to other contexts as the second wave sweeps across Europe.

scholarly journals Predictors of loss to follow-up in art experienced patients in Nigeria: a 13 year review (2004–2017)

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Ahmad Aliyu ◽  
Babatunde Adelekan ◽  
Nifarta Andrew ◽  
Eunice Ekong ◽  
Stephen Dapiap ◽  
...  
Keyword(s):  
Patient Adherence ◽  
Cross Sectional Study ◽  
Emergency Plan ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Viral Loads ◽  
Review Period ◽  
Lost To Follow Up ◽  
Differentiated Care

Abstract Background Expanded access to antiretroviral therapy (ART) leads to improved HIV/AIDS treatment outcomes in Nigeria, however, increasing rates of loss to follow-up among those on ART is threatening optimal standard achievement. Therefore, this retrospective cross-sectional study is aimed at identifying correlates and predictors of loss to follow-up in patients commencing ART in a large HIV program in Nigeria. Methods Records of all patients from 432 US CDC Presidents Emergency Plan for AIDS Relief (PEPFAR) supported facilities across 10 States and FCT who started ART from 2004 to 2017 were used for this study. Bivariate and multivariate analysis of the demographic and clinical parameters of all patients was conducted using STATA version 14 to determine correlates and predictors of loss to follow-up. Results Within the review period, 245,257 patients were ever enrolled on anti-retroviral therapy. 150,191 (61.2%) remained on treatment, 10,960 (4.5%) were transferred out to other facilities, 6926 (2.8%) died, 2139 (0.9%) self-terminated treatment and 75,041 (30.6%) had a loss to follow-up event captured. Males (OR: 1.16), Non-pregnant female (OR: 4.55), Patients on ≥ 3-monthly ARV refills (OR: 1.32), Patients with un-suppressed viral loads on ART (OR: 4.52), patients on adult 2nd line regimen (OR: 1.23) or pediatric on 1st line regimen (OR: 1.70) were significantly more likely to be lost to follow-up. Conclusion Despite increasing access to anti-retroviral therapy, loss to follow-up is still a challenge in the HIV program in Nigeria. Differentiated care approaches that will focus on males, non-pregnant females and paediatrics is encouraged. Reducing months of Anti-retroviral drug refill to less than 3 months is advocated for increased patient adherence.

Fractionated Stereotactic Radiotherapy For the Treatment of Large Arteriovenous Malformations with or without Previous Partial Embolization

Neurosurgery ◽  
2004 ◽  
Vol 55 (3) ◽  
pp. 519-531 ◽  
Author(s):  
Erol Veznedaroglu ◽  
David W. Andrews ◽  
Ronald P. Benitez ◽  
M. Beverly Downes ◽  
Maria Werner-Wasik ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Arteriovenous Malformations ◽  
Three Dimensional ◽  
Late Complications ◽  
Fractionated Stereotactic Radiotherapy ◽  
Medical Systems ◽  
Significant Treatment ◽  
Lost To Follow Up

Abstract OBJECTIVE: Despite the success of stereotactic radiosurgery, large inoperable arteriovenous malformations (AVMs) of 14 cm3 or more have remained largely refractory to stereotactic radiosurgery, with much lower obliteration rates. We review treatment of large AVMs either previously untreated or partially obliterated by embolization with fractionated stereotactic radiotherapy (FSR) regimens using a dedicated linear accelerator (LINAC). METHODS: Before treatment, all patients were discussed at a multidisciplinary radiosurgery board and found to be suitable for FSR. All patients were evaluated for pre-embolization. Those who had feeding pedicles amenable to glue embolization were treated. LINAC technique involved acquisition of a stereotactic angiogram in a relocatable frame that was also used for head localization during treatment. The FSR technique involved the use of six 7-Gy fractions delivered on alternate days over a 2-week period, and this was subsequently dropped to 5-Gy fractions after late complications in one of seven patients treated with 7-Gy fractions. Treatments were based exclusively on digitized biplanar stereotactic angiographic data. We used a Varian 600SR LINAC (Varian Medical Systems, Inc., Palo Alto, CA) and XKnife treatment planning software (Radionics, Inc., Burlington, MA). In most cases, one isocenter was used, and conformality was established by non-coplanar arc beam shaping and differential beam weighting. RESULTS: Thirty patients with large AVMs were treated between January 1995 and August 1998. Seven patients were treated with 42-Gy/7-Gy fractions, with one patient lost to follow-up and the remaining six with previous partial embolization. Twenty-three patients were treated with 30-Gy/5-Gy fractions, with two patients lost to follow-up and three who died as a result of unrelated causes. Of 18 evaluable patients, 8 had previous partial embolization. Mean AVM volumes at FSR treatment were 23.8 and 14.5 cm3, respectively, for the 42-Gy/7-Gy fraction and 30-Gy/5-Gy fraction groups. After embolization, 18 patients still had AVM niduses of 14 cm3 or more: 6 in the 7-Gy cohort and 12 in the 5-Gy cohort. For patients with at least 5-year follow-up, angiographically documented AVM obliteration rates were 83% for the 42-Gy/7-Gy fraction group, with a mean latency of 108 weeks (5 of 6 evaluable patients), and 22% for the 30-Gy/5-Gy fraction group, with an average latency of 191 weeks (4 of 18 evaluable patients) (P = 0.018). For AVMs that remained at 14 cm3 or more after embolization (5 of 6 patients), the obliteration rate remained 80% (4 of 5 patients) for the 7-Gy cohort and dropped to 9% for the 5-Gy cohort. A cumulative hazard plot revealed a 7.2-fold greater likelihood of obliteration with the 42-Gy/7-Gy fraction protocol (P = 0.0001), which increased to a 17-fold greater likelihood for postembolization AVMs of 14 cm3 or more (P = 0.003). CONCLUSION: FSR achieves obliteration for AVMs at a threshold dose, including large residual niduses after embolization. With significant treatment-related morbidities, further investigation warrants a need for better three-dimensional target definition with higher dose conformality.

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