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Orthopaedic Trauma Patient Non-adherence to Follow-up Visits at a Level 1 Trauma Center Serving an Urban and Rural Population

  • Kylee Rucinski
    Correspondence
    Corresponding Author: Kylee Rucinski, PhD Candidate, Clinical Researcher, Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, 1100 Virginia Ave, Columbia, Missouri 65212
    Affiliations
    Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia MO
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  • Emily Leary
    Affiliations
    Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia MO
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  • Brett D. Crist
    Affiliations
    Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia MO
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  • James L. Cook
    Affiliations
    Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia MO
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Published:January 20, 2023DOI:https://doi.org/10.1016/j.injury.2023.01.038

      Highlights

      • Key demographic and psychosocial factors were associated with patient adherence to scheduled follow-up appointments after treatment.
      • Various factors contribute to no-show appointments particularly in certain demographics.
      • Patients at higher risk for nonadherence should be identified to allow healthcare teams to provide better care and improve adherence for follow up appointments.

      Abstract

      Objective

      To assess key demographic and psychosocial variables that may be associated with non-adherence to clinic visits following orthopaedic trauma injuries to patients in an urban and rural population.

      Methods

      This retrospective review included all operative and non-operative patients presenting to a Level I academic trauma center serving an urban and rural population in the Midwest following an orthopaedic injury. The study tracked patient attendance to scheduled orthopaedic trauma follow-up clinic visits after a scheduled visit in the clinic following a trauma-related injury.

      Results

      Data were obtained for 5,816 unique orthopaedic trauma patients who had 21,066 post-treatment follow-up visits scheduled. 1,627 “no-show” appointments were recorded. Factors associated with no-shows included male sex, age between 26 and 35 years, self-reported race other than white, employment listed as disabled, household income below $25,000, education less than a high school level, uninsured, Medicaid insured, and relationship status reported as single.

      Conclusions

      In the present study, key demographic and psychosocial factors were significantly associated with patient adherence to scheduled follow-up appointments after treatment for orthopaedic trauma. Identifying patients at higher risk for nonadherence will allow healthcare teams to educate patients, providers, and staff, link patients to resources to enhance adherence, and work with their institutions to develop and implement protocols for improving adherence to follow-up appointments.

      Keywords

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      References

        • Casp AJ
        • Wells J
        • Holzgrefe R
        • Weiss D
        • Kahler D
        • Yarboro SR.
        Evaluation of Orthopedic Trauma Surgery Follow-up and Impact of a Routine Callback Program.
        Orthopedics. 2017; 40https://doi.org/10.3928/01477447-20161229-01
        • Tejwani NC
        • Takemoto RC
        • Nayak G
        • Pahk B
        • Egol KA.
        Who Is Lost to Followup?: A Study of Patients with Distal Radius Fractures.
        Clin Orthop Relat Res. 2010; 468: 599-604https://doi.org/10.1007/s11999-009-0968-6
        • Whiting PS
        • Greenberg SE
        • Thakore RV
        • et al.
        What factors influence follow-up in orthopedic trauma surgery?.
        Arch Orthop Trauma Surg. 2015; 135: 321-327https://doi.org/10.1007/s00402-015-2151-8
        • Kennedy AD
        • Leigh-Brown AP
        • Torgerson DJ
        • Campbell J
        • Grant A.
        Resource use data by patient report or hospital records: Do they agree?.
        BMC Health Services Research. 2002; 2: 2https://doi.org/10.1186/1472-6963-2-2
        • Shu HT
        • Bodendorfer BM
        • Folgueras CA
        • Argintar EH.
        Follow-up Compliance and Outcomes of Knee Ligamentous Reconstruction or Repair Patients Enrolled in an Electronic Versus a Traditional Follow-up Protocol.
        ORTHOPEDICS. 2018; 41: e718-e723https://doi.org/10.3928/01477447-20180828-02
        • Lysack C
        • Dama M
        • Neufeld S
        • Andreassi E.
        A compliance and satisfaction with home exercise: a comparison of computer-assisted video instruction and routine rehabilitation practice.
        J Allied Health. 2005; 34: 76-82
        • Gangavalli AK
        • Malige A
        • Rehman S
        • Nwachuku CO.
        Patient Comprehension and Compliance Survey to Assess Postoperative Pain Regimens in the Orthopaedic Trauma Population.
        J Orthop Trauma. 2017; 31: e190-e194https://doi.org/10.1097/BOT.0000000000000822
        • Chan DK
        • Lonsdale C
        • Ho PY
        • Yung PS
        • Chan KM.
        Patient motivation and adherence to postsurgery rehabilitation exercise recommendations: the influence of physiotherapists’ autonomy-supportive behaviors.
        Arch Phys Med Rehabil. 2009; 90: 1977-1982https://doi.org/10.1016/j.apmr.2009.05.024
        • Morgenstein A
        • Davis R
        • Talwalkar V
        • Iwinski H
        • Walker J
        • Milbrandt TA.
        A randomized clinical trial comparing reported and measured wear rates in clubfoot bracing using a novel pressure sensor.
        J Pediatr Orthop. 2015; 35: 185-191https://doi.org/10.1097/BPO.0000000000000205
        • Cosic F
        • Kimmel L
        • Edwards E.
        Health Literacy in Orthopaedic Trauma Patients.
        J Orthop Trauma. 2017; 31: e90-e95https://doi.org/10.1097/BOT.0000000000000764
        • Braswell M
        • Wally MK
        • Kempton LB
        • et al.
        Age and socioeconomic status affect access to telemedicine at an urban level 1 trauma center.
        OTA International: The Open Access Journal of Orthopaedic Trauma. 2021; 4: e155https://doi.org/10.1097/OI9.0000000000000155
        • Zelle BA
        • Morton-Gonzaba NA
        • Adcock CF
        • Lacci JV
        • Dang KH
        • Seifi A.
        Healthcare disparities among orthopedic trauma patients in the USA: socio-demographic factors influence the management of calcaneus fractures.
        J Orthop Surg Res. 2019; 14: 359https://doi.org/10.1186/s13018-019-1402-8
        • Sleat GKJ
        • Lefaivre KA
        • Broekhuyse HM
        • O'Brien PJ
        Predicting completion of follow-up in prospective orthopaedic trauma research.
        OTA International: The Open Access Journal of Orthopaedic Trauma. 2019; 2: e047https://doi.org/10.1097/OI9.0000000000000047
        • Stone ME
        • Marsh J
        • Cucuzzo J
        • Reddy SH
        • Teperman S
        • Kaban JM.
        Factors associated with trauma clinic follow-up compliance after discharge: experience at an urban Level I trauma center.
        J Trauma Acute Care Surg. 2014; 76: 185-190https://doi.org/10.1097/TA.0b013e3182aafcd5
        • Salim A
        • Ottochian M
        • DuBose J
        • et al.
        Does insurance status matter at a public, level I trauma center?.
        J Trauma. 2010; 68: 211-216https://doi.org/10.1097/TA.0b013e3181a0e659
        • O'Hara NN
        • Isaac M
        • Slobogean GP
        • Klazinga NS.
        The socioeconomic impact of orthopaedic trauma: A systematic review and meta-analysis.
        PLoS ONE. 2020; 15e0227907https://doi.org/10.1371/journal.pone.0227907
        • Sheridan E
        • Wiseman JM
        • Malik AT
        • et al.
        The role of sociodemographics in the occurrence of orthopaedic trauma.
        Injury. 2019; 50: 1288-1292https://doi.org/10.1016/j.injury.2019.05.018
        • Clay F
        • Newstead S
        • Watson W
        • McClure R.
        Determinants of return to work following non life threatening acute orthopaedic trauma: a prospective cohort study.
        J Rehabil Med. 2010; 42: 162-169https://doi.org/10.2340/16501977-0495
        • Sacks GD
        • Hill C
        • Rogers SO.
        Insurance status and hospital discharge disposition after trauma: inequities in access to postacute care.
        J Trauma. 2011; 71: 1011-1015https://doi.org/10.1097/TA.0b013e3182092c27
        • Andersen RM.
        Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?.
        J Health Soc Behav. 1995; 36: 1https://doi.org/10.2307/2137284
      1. Quickfacts: Columbia, Missouri.; 2019. https://www.census.gov/quickfacts/fact/table/columbiacitymissouri/PST045219

        • Van Dyne M
        • Branson L
        • Harvey B
        • Kelsey A
        • Hunter A
        Health in Rural Missouri.
        Department of Health and Senior Services, 2015
      2. Cornelius M, Wang T, Jamal A, Loretan C, Neff L. Tobacco Product Use Among Adults — United States, 2019.; 2020:1736-1742.

        • Roh YH
        • Koh YD
        • Noh JH
        • Gong HS
        • Baek GH.
        Effect of health literacy on adherence to osteoporosis treatment among patients with distal radius fracture.
        Arch Osteoporos. 2017; 12: 42https://doi.org/10.1007/s11657-017-0337-0
        • De Oliveira GS
        • McCarthy RJ
        • Wolf MS
        • Holl J.
        The impact of health literacy in the care of surgical patients: a qualitative systematic review.
        BMC Surgery. 2015; 15: 86https://doi.org/10.1186/s12893-015-0073-6
        • Summers KM
        • Deska JC
        • Almaraz SM
        • Hugenberg K
        • Lloyd EP.
        Poverty and pain: Low-SES people are believed to be insensitive to pain.
        Journal of Experimental Social Psychology. 2021; 95104116https://doi.org/10.1016/j.jesp.2021.104116
        • Abedzadeh-Kalahroudi M
        • Razi E
        • Sehat M.
        The relationship between socioeconomic status and trauma outcomes.
        J Public Health (Oxf). 2018; 40: e431-e439https://doi.org/10.1093/pubmed/fdy033
        • Gopinath B
        • Jagnoor J
        • Harris IA
        • et al.
        Health-related quality of life 24 months after sustaining a minor musculoskeletal injury in a road traffic crash: A prospective cohort study.
        Traffic Injury Prevention. 2017; 18: 251-256https://doi.org/10.1080/15389588.2016.1244335
        • Hoffman KM
        • Trawalter S
        • Axt JR
        • Oliver MN.
        Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites.
        Proc Natl Acad Sci USA. 2016; 113: 4296-4301https://doi.org/10.1073/pnas.1516047113
        • Aaland MO
        • Marose K
        • Zhu TH.
        The lost to trauma patient follow-up: a system or patient problem.
        J Trauma Acute Care Surg. 2012; 73: 1507-1511https://doi.org/10.1097/TA.0b013e31826fc928
        • Avilucea FR
        • Szalay EA
        • Bosch PP
        • Sweet KR
        • Schwend RM.
        Effect of cultural factors on outcome of Ponseti treatment of clubfeet in rural America.
        J Bone Joint Surg Am. 2009; 91: 530-540https://doi.org/10.2106/JBJS.H.00580
        • Martin LR
        • Williams SL
        • Haskard KB
        • DiMatteo MR.
        The challenge of patient adherence.
        Ther Clin Risk Manag. 2005; 1: 189-199
        • Wright BJ
        • Galtieri NJ
        • Fell M.
        Non-adherence to prescribed home rehabilitation exercises for musculoskeletal injuries: the role of the patient-practitioner relationship.
        J Rehabil Med. 2014; 46: 153-158https://doi.org/10.2340/16501977-1241
        • Campbell R
        • Evans M
        • Tucker M
        • Quilty B
        • Dieppe P
        • Donovan JL.
        Why don't patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee.
        J Epidemiol Community Health. 2001; 55: 132-138https://doi.org/10.1136/jech.55.2.132
        • Frymoyer JW
        • Frymoyer NP.
        Physician-patient communication: a lost art?.
        J Am Acad Orthop Surg. 2002; 10: 95-105https://doi.org/10.5435/00124635-200203000-00005
        • Drew S
        • Lavy C
        • Gooberman-Hill R.
        What factors affect patient access and engagement with clubfoot treatment in low- and middle-income countries? Meta-synthesis of existing qualitative studies using a social ecological model.
        Trop Med Int Health. 2016; 21: 570-589https://doi.org/10.1111/tmi.12684
        • Vernon D
        • Brown JE
        • Griffiths E
        • Nevill AM
        • Pinkney M.
        Reducing readmission rates through a discharge follow-up service.
        Future Healthc J. 2019; 6: 114-117https://doi.org/10.7861/futurehosp.6-2-114
        • Xiong G
        • Greene NE
        • Lightsey HM
        • et al.
        Telemedicine Use in Orthopaedic Surgery Varies by Race, Ethnicity, First Language, and Insurance Status.
        Clin Orthop Relat Res. 2021; (Publish Ahead of Print)https://doi.org/10.1097/CORR.0000000000001775
        • Overton TL
        • Shafi S
        • Gandhi RR.
        Local access to care programs increase trauma patient follow-up compliance.
        Am J Surg. 2014; 208: 476-479https://doi.org/10.1016/j.amjsurg.2013.11.008
        • Busse JW
        • Heels-Ansdell D
        • Makosso-Kallyth S
        • et al.
        Patient coping and expectations predict recovery after major orthopaedic trauma.
        Br J Anaesth. 2019; 122: 51-59https://doi.org/10.1016/j.bja.2018.06.021
        • Andersson V
        • Otterstrom-Rydberg E
        • Karlsson AK.
        The Importance of Written and Verbal Information on Pain Treatment for Patients Undergoing Surgical Interventions.
        Pain Manag Nurs. 2015; 16: 634-641https://doi.org/10.1016/j.pmn.2014.12.003
        • Haider AH
        • Weygandt PL
        • Bentley JM
        • et al.
        Disparities in trauma care and outcomes in the United States: a systematic review and meta-analysis.
        J Trauma Acute Care Surg. 2013; 74: 1195-1205https://doi.org/10.1097/TA.0b013e31828c331d
        • Rucinski K
        • Cook JL
        • Crecelius CR
        • Stucky R
        • Stannard JP.
        Effects of Compliance With Procedure-Specific Postoperative Rehabilitation Protocols on Initial Outcomes After Osteochondral and Meniscal Allograft Transplantation in the Knee.
        Orthop J Sports Med. 2019; 72325967119884291https://doi.org/10.1177/2325967119884291
        • Roberts L
        • Cornell C
        • Bostrom M
        • et al.
        Communication Skills Training for Surgical Residents: Learning to Relate to the Needs of Older Adults.
        J Surg Educ. 2018; 75: 1180-1187https://doi.org/10.1016/j.jsurg.2018.02.005
        • Akintayo OA
        • Adegbehingbe O
        • Cook T
        • Morcuende JA.
        Initial program evaluation of the Ponseti method in Nigeria.
        Iowa Orthop J. 2012; 32: 141-149
        • van Netten JJ
        • Jannink MJA
        • Hijmans JM
        • Geertzen JHB
        • Postema K.
        Use and usability of custom-made orthopedic shoes.
        J Rehabil Res Dev. 2010; 47: 73-81https://doi.org/10.1682/jrrd.2009.08.0142
        • Olaisen RH
        • Schluchter MD
        • Flocke SA
        • Smyth KA
        • Koroukian SM
        • Stange KC.
        Assessing the Longitudinal Impact of Physician-Patient Relationship on Functional Health.
        Ann Fam Med. 2020; 18: 422-429https://doi.org/10.1370/afm.2554
        • Martinez-Rico S
        • Lizaur-Utrilla A
        • Sebastia-Forcada E
        • Vizcaya-Moreno MF
        • de Juan-Herrero J.
        The Impact of a Phone Assistance Nursing Program on Adherence to Home Exercises and Final Outcomes in Patients Who Underwent Shoulder Instability Surgery: A Randomized Controlled Study.
        Orthop Nurs. 2018; 37: 372-378https://doi.org/10.1097/NOR.0000000000000501