Lucía García San Miguel, Verónica Iglesias, Isabel. Hornero, Fernando Sacristán ... Farmacia (Miguel Angel Rodriguez-Sagrado); y Servicio de Estadística ...
Brief Report
Missing Scheduled Visits in the Outpatient Clinic as a Marker of Short-Term Admissions and Death María Martínez Colubi,1 María Jesús Pérez-Elías,1 Laura Elías,1 María Pumares,1 Alfonso Muriel,2 Ana Moreno Zamora,1 Jose Luis Casado,1 Fernando Dronda,1 Dolores López,1 Santiago Moreno,1 and the SEAD Study Group* 1 Infectious Diseases Department, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ramón y Cajal Hospital, Madrid, Spain; 2Biostatistics Unit, IRYCIS, Consorcio de Investigación Biomédica en Red especializado en Epidemiología y Salud Pública (CIBERESP), Ramón y Cajal Hospital, Madrid, Spain
Introduction: It is not uncommon for patients with HIV infection to miss scheduled visits in outpatient clinics without justifying the failure to appear or reschedule the appointment. Few studies have assessed the impact of inconsistent follow-ups on resource use and disease outcomes in this patient population. Objective: To assess the effect of missing scheduled visits to the outpatient clinic on the health outcomes of HIV-infected patients. Methods: Between January and June 2006, we conducted a prospective observational study monitoring assistance at an outpatient HIV/AIDS clinic of a tertiary hospital within a public health care system in a developed country. The short-term subsequent events (deaths and admissions) of the population were observed from January to December 2006. Results: Of the 1,733 HIV patients who were scheduled in the outpatient clinic, 103 met the criteria of missing scheduled visit (5.9%). Hospital admissions and mortality rates were significantly higher in the missing scheduled visit group compared to non–missing scheduled visits (27.2% vs 8.9%; P < .001 and 5.8% vs 0.7%; P < .001, respectively). Patients with missing scheduled visits had a higher risk of hospital admissions (odds ratio [OR] 2.4; 95% CI, 1.4–4) and mortality (OR 6.7; 95% CI, 2.2–18.5) adjusted by age, CD4 cell count, HIV stage, and category of transmission. Conclusions: Missing scheduled visits was an independent predicting factor for hospital admission and mortality. It is warranted to monitor and implement resources to reduce missed appointments. Key words: HIV, hospital admissions, lost to follow-up, missing scheduled visits, mortality
n countries with comprehensive health coverage, the introduction of combination antiretroviral therapy has turned HIV infection into a chronic disease, with resulting dramatically reduced morbidity and mortality.1 However, additional challenges have emerged, such as lack of adherence to treatment, drug resistance, drug toxicities, and coexistence of other comorbidities or loss to follow-up consultations. Missing scheduled visits (MSV) to the HIV outpatient clinic and, in some cases, subsequent permanent loss to follow-up are serious problems observed in the daily practice of HIV management and in clinical trials.2
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*Members of the SEAD Study Group are listed in the Acknowledgments.
Studies about the underlying reasons for MSV and its clinical consequences are limited and most of them have been conducted in developing countries. 3–5 Prevalence and factors influencing MSV are different between studies.6,7 The definition of this problem, the ways of naming it (lost to follow-up, MSV, not retaining in care, etc), the study periods (from 1997–2000s), and locations (South Africa, Address for correspondence: Dr. María Jesús Pérez-Elías, Servicio de Enfermedades Infecciosas, 4ª centro control A, Hospital Ramón y Cajal, Cta. Colmenar Km 9.100, Madrid 28034 Spain; phone: +34 91 336 82 38; e-mail: mjperez90@gmailcom HIV Clin Trials 2012;13(5):289–295 © 2012 Thomas Land Publishers, Inc. www.thomasland.com doi: 10.1310/hct1305-289
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Eastern Europe, Western Europe, Canada, United States) vary, which makes it difficult to compare results.8 –11 Risk factors influencing a higher prevalence of loss to follow-up include demographic characteristics of being male,12,13 immigrant,6,14,15 and younger,3 – 5 having heterosexual orientation,7 having a history of or current consumption of intravenous drugs,14 – 18 and belonging to a lower social class6 and clinical characteristics of not receiving antiretroviral treatment,7,8 having a greater number of CD4 cell counts,3,6,18 or having a recent HIV infection (
