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Pediatric appointment keeping: improving adherence in a primary care allergy clinic
J W Finney1, K L Lemanek, C J Brophy
1Department of Psychology, Virginia Polytechnic Institute, State University, Blacksburg 24061-0436.
Insights
Incentives improved appointment keeping in a pediatric allergy clinic, but this effect diminished when incentives were removed. Continued reminders alone did not maintain adherence, highlighting the need for further research into effective adherence strategies.
Area of Science:
- Pediatric Psychology
- Health Services Research
- Behavioral Science
Background:
- Patient adherence to scheduled appointments is crucial for effective healthcare delivery, particularly in pediatric specialty clinics.
- Nonadherence can lead to fragmented care, increased healthcare costs, and poorer health outcomes.
- Developing and evaluating interventions to improve appointment adherence is a significant challenge in pediatric healthcare.
Purpose of the Study:
- To evaluate the impact of introducing and subsequently discontinuing an intervention aimed at improving appointment adherence in a pediatric allergy clinic.
- To assess the effectiveness of reminders and incentives in enhancing appointment keeping among nonadherent pediatric patients.
- To determine if adherence improvements are sustained after the discontinuation of incentives.
Main Methods:
- A study involving five nonadherent and three adherent pediatric patients in an allergy clinic.
- Implementation of a combined reminder and incentive strategy for scheduled appointments.
- Discontinuation of incentives while continuing reminders after a specified adherence threshold was met.
- Comparison of adherence rates during the intervention and post-intervention phases.
Main Results:
- Adherence improved by an average of 13% for three of the five nonadherent children during the intervention.
- Adherent patients maintained their appointment-keeping rates throughout the intervention period.
- Following the discontinuation of incentives, adherence improvements were not sustained, with two children showing decreased adherence below baseline levels.
Conclusions:
- Incentive programs can effectively increase appointment adherence in pediatric allergy clinics.
- Abruptly discontinuing incentives may lead to a relapse in nonadherence, even with ongoing reminders.
- Further research is needed to explore the long-term benefits and limitations of various adherence improvement strategies in pediatric psychology practice.
Abstract:
We evaluated the effects of introducing and discontinuing an intervention designed to improve adherence with scheduled appointments in a pediatric allergy clinic. Five nonadherent and three adherent patients received reminders and incentives for keeping their scheduled appointments. Adherence with appointments increased for three of the five nonadherent children, who had an average increase of 13%, and adherent patients continued to keep appointments during the intervention condition. After 10 scheduled allergy clinic appointments had been kept, incentives were discontinued while reminders continued. Improvements in adherence were not maintained after incentives were discontinued and two children showed reductions in adherence to below-baseline levels. Incentive programs increase appointment keeping, but discontinuing incentives abruptly may result in the return of nonadherence, even when reminders are provided as a maintenance strategy. Future pediatric psychology research and practice should investigate both the benefits and limitations of strategies designed to improve adherence.