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Failure to Follow Up: Predictors of “No-Show” for Medically Advised Imaging
Rachel A. Moses, MD, MPH1, Lawrence M. Dagrosa, MD1, Elias S. Hyams, MD1, Peter Steinberg, MD2, Vernon M. Pais, Jr., MD1.
1Section of Urology, Dartmouth Hitchock Medical Center, Lebanon, NH, USA, 2Section of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Abstract
Background: Poor compliance with follow-up after endoscopic treatment of stones may negatively impact patient safety and, ultimately, the quality of care. Many factors including gender, age, travel distance and health insurance coverage have been implicated in missed appointments after discharge. However, to date, no studies have evaluated predictors of poor compliance after treatment of urinary stone disease.
Methods: We performed an IRB-approved, retrospective analysis of patients who underwent stent removal following percutaneous nephrolithotomy (PCNL) or ureteroscopy (URS) between 2008 and 2011. All patients were scheduled for follow-up evaluation and renal ultrasound at 4-6 weeks following stent removal. Patients were stratified based on appointment compliance. Demographic variables including gender, age, insurance type (Government Assisted Insurance [GAI] or Private Insurance [PI]), initial procedure, season, distance between home and clinic, average monthly gas price at follow up, and median education attainment were compared using chi square and student t-tests. Logistic regression was performed to determine independent predictors of missed follow-up.
Results: A total of 301 patients were included, 153 women (51% female) with a mean age of 54.±14.2 years. Of the cohort, 22.6% (n = 68) did not return for follow up. GAI was the only variable associated with a greater risk of non-compliance on univariate analysis (OR 2.13 [95% CI 1.12-3.86] p=0.011) and multivariate analysis (OR 3.14.10 [95% CI 1.48-6.7], p<0.01). Gender, age, procedure, season, distance, gas prices, and education were not significant predictors.
Conclusion: In our study evaluating characteristics associated with missed follow-up after stent removal for PCNL and URS, possession of GAI was the only factor associated with non-compliance. Urologists should be aware that persons with GAI may be at increased risk of missed follow up and should use this information to target interventions to improve compliance.
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