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Experimental design: impact of an intervention to improve clinic attendance of patients with non-communicable diseases through telephone follow-up

Authors
Journal
The Lancet
0140-6736
Publisher
Elsevier
Publication Date
Volume
381
Identifiers
DOI: 10.1016/s0140-6736(13)61317-3
Keywords
  • Supplement
  • Meeting Abstracts
Disciplines
  • Medicine

Abstract

Abstract Background Elderly people often neglect their routine clinic appointments and have little concern for the routine drugs they take for their non-communicable diseases (NCDs). Therefore, these individuals will most likely discontinue treatment. Little evidence exists on whether follow-up phone calls to address these missed clinic appointments can help sustain drug use for NCDs. This study aimed to study the impact of routine scheduled appointments for patients with NCDs and follow-up telephone calls for individuals who missed their scheduled appointments. Methods Between the years 2009 and 2012, a total of 792 patients with NCDs attending medical clinics at Base Hospital Elpitiya in Sri Lanka were randomly assigned to receive regular clinic services by receiving routine clinic appointment times. Patients were reminded if they missed or had forgotten to attend their clinic appointment through follow-up phone calls over the 12 months the patient participated in the study. Patients were surveyed for their control of NCDs by measuring blood pressure and fasting blood sugar at baseline and completion. Previous levels of appointment attendance and levels of control of NCDs were analysed through patient's clinic records (before intervention). Multiple linear and logistic regression analyses were used to assess the programme's effects. Findings Patients' attendance to the clinics was remarkably improved with regular clinic service and follow-up phone calls from 35–60% to 85–90%. The rate of clinic attendance increased dramatically over the period from 6 months to 12 months after the intervention. More patients had control of blood pressure (<140/90 mm Hg) and fasting blood sugar levels (<8·33 mmol/L) under the desirable levels after the intervention compared with before the intervention (p=0·001). Patients who died during their involvement in the study allowed for additional individuals to be enrolled in the programme. Overall, the intervention improved clinic utilisation and satisfaction. Interpretation Encouraging patients to attend routine clinic appointments by developing a reminder system and regular clinic service is challenging and does appear to provide significant realistic benefits. Benefits observed in this study were the maintaining of NCDs in controllable levels. Funding None.

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