No-shows to primary care appointments: subsequent acute care utilization among diabetic patients
<p>Abstract</p> <p>Background</p> <p>Patients who no-show to primary care appointments interrupt clinicians’ efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-sh...
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| Format: | Article |
| Language: | English |
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BMC
2012-09-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://www.biomedcentral.com/1472-6963/12/304 |
| _version_ | 1811275850316775424 |
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| author | Nuti Lynn A Lawley Mark Turkcan Ayten Tian Zhiyi Zhang Lingsong Chang Karen Willis Deanna R Sands Laura P |
| author_facet | Nuti Lynn A Lawley Mark Turkcan Ayten Tian Zhiyi Zhang Lingsong Chang Karen Willis Deanna R Sands Laura P |
| author_sort | Nuti Lynn A |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Patients who no-show to primary care appointments interrupt clinicians’ efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-shows to primary care appointments are associated with increased risk of future emergency department (ED) visits or hospital admissions among diabetics.</p> <p>Methods</p> <p>A prospective cohort study was conducted using data from 8,787 adult diabetic patients attending outpatient clinics associated with a medical center in Indiana. The outcomes examined were hospital admissions or ED visits in the 6 months (182 days) following the patient’s last scheduled primary care appointment. The Andersen-Gill extension of the Cox proportional hazard model was used to assess risk separately for hospital admissions and ED visits. Adjustment was made for variables associated with no-show status and acute care utilization such as gender, age, race, insurance and co-morbid status. The interaction between utilization of the acute care service in the six months prior to the appointment and no-show was computed for each model.</p> <p>Results</p> <p>The six-month rate of hospital admissions following the last scheduled primary care appointment was 0.22 (s.d. = 0.83) for no-shows and 0.14 (s.d. = 0.63) for those who attended (<it>p</it> < 0.0001). No-show was associated with greater risk for hospitalization only among diabetics with a hospital admission in the prior six months. Among diabetic patients with a prior hospital admission, those who no-showed were at 60% greater risk for subsequent hospital admission (HR = 1.60, CI = 1.17–2.18) than those who attended their appointment. The six-month rate of ED visits following the last scheduled primary care appointment was 0.56 (s.d. = 1.48) for no-shows and 0.38 (s.d. = 1.05) for those who attended (<it>p</it> < 0.0001); after adjustment for covariates, no-show status was not significantly related to subsequent ED utilization.</p> <p>Conclusions</p> <p>No-show to a primary care appointment is associated with increased risk for hospital admission among diabetics recently hospitalized.</p> |
| first_indexed | 2024-04-12T23:46:12Z |
| format | Article |
| id | doaj.art-c27cd33126ed47038a0fea166641fe39 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-12T23:46:12Z |
| publishDate | 2012-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-c27cd33126ed47038a0fea166641fe392022-12-22T03:11:51ZengBMCBMC Health Services Research1472-69632012-09-0112130410.1186/1472-6963-12-304No-shows to primary care appointments: subsequent acute care utilization among diabetic patientsNuti Lynn ALawley MarkTurkcan AytenTian ZhiyiZhang LingsongChang KarenWillis Deanna RSands Laura P<p>Abstract</p> <p>Background</p> <p>Patients who no-show to primary care appointments interrupt clinicians’ efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-shows to primary care appointments are associated with increased risk of future emergency department (ED) visits or hospital admissions among diabetics.</p> <p>Methods</p> <p>A prospective cohort study was conducted using data from 8,787 adult diabetic patients attending outpatient clinics associated with a medical center in Indiana. The outcomes examined were hospital admissions or ED visits in the 6 months (182 days) following the patient’s last scheduled primary care appointment. The Andersen-Gill extension of the Cox proportional hazard model was used to assess risk separately for hospital admissions and ED visits. Adjustment was made for variables associated with no-show status and acute care utilization such as gender, age, race, insurance and co-morbid status. The interaction between utilization of the acute care service in the six months prior to the appointment and no-show was computed for each model.</p> <p>Results</p> <p>The six-month rate of hospital admissions following the last scheduled primary care appointment was 0.22 (s.d. = 0.83) for no-shows and 0.14 (s.d. = 0.63) for those who attended (<it>p</it> < 0.0001). No-show was associated with greater risk for hospitalization only among diabetics with a hospital admission in the prior six months. Among diabetic patients with a prior hospital admission, those who no-showed were at 60% greater risk for subsequent hospital admission (HR = 1.60, CI = 1.17–2.18) than those who attended their appointment. The six-month rate of ED visits following the last scheduled primary care appointment was 0.56 (s.d. = 1.48) for no-shows and 0.38 (s.d. = 1.05) for those who attended (<it>p</it> < 0.0001); after adjustment for covariates, no-show status was not significantly related to subsequent ED utilization.</p> <p>Conclusions</p> <p>No-show to a primary care appointment is associated with increased risk for hospital admission among diabetics recently hospitalized.</p>http://www.biomedcentral.com/1472-6963/12/304No-showDiabetesEmergency department visitsHospital admissionsOutcomes |
| spellingShingle | Nuti Lynn A Lawley Mark Turkcan Ayten Tian Zhiyi Zhang Lingsong Chang Karen Willis Deanna R Sands Laura P No-shows to primary care appointments: subsequent acute care utilization among diabetic patients BMC Health Services Research No-show Diabetes Emergency department visits Hospital admissions Outcomes |
| title | No-shows to primary care appointments: subsequent acute care utilization among diabetic patients |
| title_full | No-shows to primary care appointments: subsequent acute care utilization among diabetic patients |
| title_fullStr | No-shows to primary care appointments: subsequent acute care utilization among diabetic patients |
| title_full_unstemmed | No-shows to primary care appointments: subsequent acute care utilization among diabetic patients |
| title_short | No-shows to primary care appointments: subsequent acute care utilization among diabetic patients |
| title_sort | no shows to primary care appointments subsequent acute care utilization among diabetic patients |
| topic | No-show Diabetes Emergency department visits Hospital admissions Outcomes |
| url | http://www.biomedcentral.com/1472-6963/12/304 |
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