Factors Influencing Nonadherence to Recommended Postdischarge Follow-Up After Trauma

Truong, Evelyn I.; DeMario, Belinda S; Hendrickson, Sarah; Kalina, Mark; Vallier, Heather A.; Tseng, Esther S.; Claridge, Jeffrey A.; Ho, Vanessa P.

doi:10.1016/j.jss.2020.06.009

Cited by 20 publications

(18 citation statements)

References 13 publications

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“…Given limited resource settings like Moshi, Tanzania, solutions employed in high-income settings, such as dedicated non-emergent medical transport vehicles and readily available assistive devices, such as wheelchairs, may not be applicable. Therefore, focusing on cost-effective solutions such as creating complex coordinated care plans upon hospital discharge and providing detailed patient and caregiver discharge education may be of immediate benefit [36]. Interventions to decrease the financial burden placed on patients after injury, such as investing in unconditional vouchers or reduced cost transportation schemes with vehicles equipped to accommodate a physically disabled patient population also warrant further investigation.…”

Section: Discussionmentioning

confidence: 99%

Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study

Joiner

Tupetz

Peter

et al. 2022

PLOS Glob Public Health

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Disproportionately high injury rates in Sub-Saharan Africa combined with limited access to care in both the acute injury phase and for injury patients requiring continued care after hospital discharge remains a challenge. We aimed to characterize barriers to transportation and access to care in a cohort of post-hospitalized injury patients in Moshi, Tanzania. This was a mixed-methods study of a prospective cohort of trauma registry patients presenting to Kilimanjaro Christian Medical Center between August 2018 and January 2020. We conducted standardized patient/family surveys and in-depth interviews at a 2-week follow up visit after hospital discharge, and focus groups with healthcare providers. Quantitative results were analyzed using descriptive statistics and multivariable logistic regression using R statistical software. Qualitative results were analyzed using thematic analysis through an iterative process using NVivo software. A total of 1,365 patients were enrolled in the trauma registry, with 169 patients followed up at 2 weeks. Over half of patients at follow-up, 101 (59.8%), reported challenges in traveling. The majority of patients were male (80.3%). Difficulty in traveling since injury was associated with female gender (aOR 5.85 [95% CI 1.20–33.59]) and a need for non-family members escorts for travel (aOR 7.10 [95% CI 1.43–41.66]). Those who reported assault or fall as the mechanism of injury as compared to road traffic injury and had health insurance were less likely to report challenges in traveling (aOR 0.19 [95% CI 0.03–0.90]), 0.11 [95% CI 0.01–0.61], 0.14 [95% 0.02–0.80]). Transportation barriers that emerged from qualitative data included inability to use regular means of transportation, financial challenges, physical barriers, rigid compliance to physician orders, access to healthcare, and social support barriers. Our findings demonstrate several areas to address transportation barriers for post-injury patients in Tanzania. Educational interventions such as clarification of doctors’ orders of strict bedrest, provision of vouchers to support financial challenges and alternate means of transportation given physical barriers and reliance on social support may address some of these barriers.

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Section: Discussionmentioning

confidence: 99%

Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study

Joiner

Tupetz

Peter

et al. 2022

PLOS Glob Public Health

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“…We included 392 patients (median age 45 , ISS 14 [10][11][12][13][14][15][16][17][18][19][20][21]). 55 patients (14%) had DIerrors.…”

Section: Resultsmentioning

confidence: 99%

Post-Trauma Discharge Instructions: Are We Dropping the Ball?

Flippin

DeMario

Adomshick

et al. 2022

The American Surgeon™

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Introduction Complex follow-up plans for polytrauma patients are compiled at the end of hospitalization into discharge instructions. We sought to identify how often patient discharge instructions incorrectly communicated specialist recommendations. We hypothesized that patients with more complex hospitalizations would have more discharge instruction errors (DI-errors). Methods We reviewed adult trauma inpatients (March 2017-March 2018), excluding those who left against medical advice or were expected to follow up outside our system. Complex hospitalizations were represented using injury severity (ISS), hospital length of stay (LOS), intensive care unit length of stay (iLOS), and number of consultants (NC). We recorded the type of consultant (surgical or nonsurgical), and consultant recommendations for follow-up. DI-errors were defined as either follow-up necessary but omitted or follow-up not necessary yet present on the instructions. Patients with DI-errors were compared to patients without DI-errors. Groups were compared using Wilcoxon rank sum or chi-square (alpha <.05). Results We included 392 patients (median age 45 [IQR 26-58], ISS 14 [10-21], LOS 6 [3-11]). 55 patients (14%) had DI-errors. Factors associated with DI-errors included the total number of consultants and use of nonsurgical consultants. ISS, LOS, iLOS, were not associated with DI-errors. Conclusion Common measures of admission complexity were not associated with DI-errors, although the number and type of consultants were associated with DI-errors. Non-surgical specialty consultant recommendations were more likely to be omitted. It is crucial for patients to receive accurate discharge instructions, and systematic processes are needed to improve communication with the patients at discharge.

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“…The follow-up instructions included interval of follow-up appointments, the name of their physicians, the phone number of clinic, and the directions to the clinic. There was no accordant standard de nition of LTFU so far [19]. Based on previous studies [7], we referred to their de nition to identify those who didn't attend their scheduled appointment.…”

Section: Methodsmentioning

confidence: 99%

Loss to follow-up after surgery in patients with hip fractures

Min

Hui

Peng

et al. 2022

Preprint

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Background: Non-attendance with scheduled postoperative follow-up visits remains a common problem in orthopaedic clinical researches. The goal of this study was to determine the risk factors for loss to follow-up of hip-fracture patients postoperatively. Methods: A 1-year postoperatively retrospective analysis was conducted on patients who underwent surgery for hip-fractures between January 2017 and December 2018. According to whether they finished the appointed follow-up schedule, the patients were divided into two groups: LTFU Group (Follow-up loss group) and FU Group (Follow-up group). Patients’ clinical outcomes were evaluated by Functional Recovery Score (FRS) questionnaires. Telephone interviews were attempted on those lost to follow-up to determine the reasons. The baseline characteristics between the two groups were compared and the statistical differences were analyzed by logistic regression. Results: 1,041 patients met the inclusion criteria were included in this study, of which 212 (20.37%) patients were lost to follow-up at 1 year postoperatively. The mean age in LTFU Group was 76.70±12.78 and 71.31±13.87 in FU Group (P<0.001). The FRS in LTFU Group were higher than that of FU group (84.0 vs. 82.0, P=0.083), with no significant difference. The logistic regression analysis showed that old age at surgery, fracture type, distance to hospital, Hemiarthroplasty surgery and patients’ transport to hospital by urban-rural public traffic or bus were found to be risk factors for noncompliance with the follow-up visit. Conclusions: Loss to follow-up was common in patients with hip-fracture postoperatively. Our study suggested advanced age, difficult transport, long distance, fracture type and surgical procedures were risk factors for noncompliance. Key Words Hip Fracture, Orthopaedic surgery, Replacement, Internal fixation, Loss, Follow-up

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Factors Influencing Nonadherence to Recommended Postdischarge Follow-Up After Trauma

Cited by 20 publications

References 13 publications

Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study

Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study

Post-Trauma Discharge Instructions: Are We Dropping the Ball?

Loss to follow-up after surgery in patients with hip fractures

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