Distance to clinic and follow-up visit compliance in adolescent gastric bypass cohort

Abstract

Background Regular follow-up after bariatric surgery is important to assess the clinical status. Various factors could influence retention (i.e., compliance with clinical follow-up). The present analysis tested the hypothesis that the distance from the center will influence clinical retention for adolescent bariatric surgery patients. Our aim was to determine whether the distance to the clinic, and other patient characteristics, would predict clinical follow-up compliance. The present study was conducted at a tertiary care, free-standing children’s hospital. Methods The Follow-up of Adolescent Bariatric Surgery (FABS) study is a single-center cohort study collecting demographic and clinical information. The subjects’ addresses were geocoded, and the distance to the clinic was calculated. A generalized estimating equations model was used to examine follow-up visit compliance. Results A total of 71 subjects underwent Roux-en- gastric bypass surgery (RYGB), with a mean body mass index of 59 kg/m2. The average distance to the clinic was 98 miles. Retention declined over time (6 mo, 94%; 1 yr, 89%; 2 yr, 69%; P < .01); however, distance was not associated with retention (P = .68). Age at surgery was inversely related to retention (P = .04). Conclusion Compliance with clinical follow-up decreased 1 and 2 years after RYGB in adolescents. The distance from the center was not associated with follow-up regimen compliance. However, increasing age was associated with decreased retention. Additional research should focus on determining the modifiable factors that influence retention.

Predictors and correlates of follow-up visit adherence among adolescents receiving laparoscopic adjustable gastric banding

“…In this study, other factors, including distance from the medical center, gender, and initial BMI were not significant predictors of adherence to clinic appointments. This finding contrasts studies of adults (42) , but replicates the one other study of adolescents (20) . Unlike prior work with younger (20) and older (18) patients, age was not related to attendance.…”

“…Like previous research (20) , only information about visit attendance was available for all participants, which is only one component of adherence (3) , and it is possible that data on other aspects of postoperative behavior (e.g., adherence to nutritional recommendations) are more relevant in this population. In addition, the original protocol for clinic visits was potentially burdensome, as evidenced by only one adolescent (1.0%) attending all 17 expected appointments, and three of these appointments occurred outside the expected time-frame.…”

“…Similar to other studies (11, 20) , participants’ home addresses were obtained from clinical charts, and Google maps determined the travel distance from the adolescent’s home to the medical center campus.…”

“…Adolescence is a unique developmental stage characterized by notable rates of non adherence and the initiation of self-management of medical care for chronic illnesses (3, 19) . Among adolescents receiving bariatric surgery, adherence to postoperative diet is incomplete (9) , and attendance at routine visits following gastric bypass declines over time (20) . To date, adherence behaviors have not been examined among adolescents undergoing LAGB.…”

Challenging Recruitment of Youth With Type 2 Diabetes Into Clinical Trials

“…For example, the Oklahoma site of the TODAY trial provided transportation and home visits for follow-up appointments. Similarly, the Teen–Longitudinal Assessment of Bariatric Surgery study achieved sustained patient retention with in-home follow-up visits for patients unable to attend clinic appointments [22,23]. Here, we further explore potential approaches to improve recruitment and retention of youth with type 2 diabetes, by reviewing our experience at three U.S. sites and the published literature on adolescent recruitment.…”