INVESTIGATING NURSE PHONE INTERVENTIONS ON PATIENTS' APPOINTMENT ATTENDANCE
Access to quality healthcare in the United States has become a significant problem. Decreased patient adherence to attending clinic appointments reduces available slots, limits the number of patients served, and adds expense, inefficiency, and frustration to health professionals. Literature review yielded multiple studies investigating attendance of medical appointments and possible improvements; however, none of the studies included registered nurses who provided personalized education, and encouragement via the telephone. This study, a quantitative, quasi-experimental design, sought to explore what effect nurse interventions had on patients’ motivations to attend their medicine specialty clinic appointments.
Rationale/Conceptual Basis/Background
The Emergency Department sees patients for non-emergent, acute symptoms and for chronic conditions not managed by primary care providers. Literature supports that medical centers globally suffer similar overuse of Emergency Departments. In this institution, the emergency physicians refer many patients to specialty care via the Physician Access Line asking providers to overbook patients into already booked clinics. Many of these no-show and are lost to follow-up until they return to the Emergency Department seeking care. If patients would attend every scheduled appointment, practitioners could increase clinic sessions. Patients may not need to utilize the Emergency Department for non-emergent health care needs, and access may be improved.
Methods
During the three-week study period, the RN utilized telephonic contact with 387 patients who had upcoming appointments to obtain consent, provide education regarding clinic processes, conduct semi-structured interviews, and gather data. The information was used to determine if the patients in the study group arrived more frequently for the appointments in comparison to a control group who did not receive the education and with the previous year’s no-show rates. Data were analyzed in respect to education, attendance and no-show rates, transportation plans, reasons for reschedule or cancellation, and ability to contact. Fisher’s Exact Test verified significance of the study.
The research question was, “What are the results of an established relationship between the specialty nurse and the diabetes care, pulmonary, or rheumatology patient via pre-appointment telephone interview on patient appointment adherence?”
Results
This study determined that patients who were reached and educated attended medicine specialty appointments at a significantly higher rate than ones who were not. No-show rates decreased in the study group as compared to the control group and to last year’s no-show rates. Patients were reached more frequently than anticipated, most had transportation plans, lack of transportation and financial issues caused cancellations, and patients needed further medication education.
Implications
Recommendations include expansion of the study to other clinics and focusing on the RN to patient relationships in future investigations. This process has the potential to contribute to increased patient and nurse satisfaction, enhanced patient education, understanding, and adherence, and improved healthcare access.