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Attendance in a Neonatal Follow-Up Program before and in the Time of COVID-19 Pandemic: A Mixed
Evdoxia Nantsi1, Ilias Chatziioannidis2, Abraham Pouliakis3
1Laboratory of Primary Health Care, School of Medicine, General Medicine and Health Services Research Aristotle University, 54124 Thessaloniki, Greece.
Insights
COVID-19 significantly impacted neonatal follow-up program attendance. Barriers like provider issues and fear emerged, while factors like citizenship and infant morbidity encouraged participation. Addressing these barriers is key to improving attendance.
Area of Science:
- Neonatal care and high-risk infant follow-up
- Public health and healthcare system impact during pandemics
Background:
- Neonatal follow-up programs are crucial for positive long-term outcomes in high-risk infants.
- Maximizing participation in these programs benefits interventions, healthcare systems, and society.
- While studies exist on attrition, none specifically addressed COVID-19's impact on neonatal follow-up non-compliance.
Purpose of the Study:
- To identify key factors contributing to non-compliance with neonatal follow-up programs during the COVID-19 pandemic.
- To compare pre-pandemic and pandemic-era reasons for non-attendance in a tertiary hospital's program.
Main Methods:
- An ambidirectional observational study involving 1137 high-risk neonates (573 pre-COVID-19, 564 during COVID-19).
- Participants were categorized into: maintained participation (G1), discontinued (G2), and never attended (G3).
- Data sourced from hospital SAP software and structured questionnaires via telephone contact with parents of G2 and G3.
Main Results:
- Pre-pandemic: Perceived lack of necessity was the primary reason for discontinuance (44.12%).
- During COVID-19: Provider-related access barriers (37.14%) and fear/insecurity (18.5%) became significant factors.
- Citizenship and infant morbidity (e.g., respiratory distress syndrome, sepsis) incentivized program participation throughout.
- Multiple gestation infants showed higher odds of continued participation during COVID-19 (OR, 4.04).
Conclusions:
- Understanding COVID-19's impact on neonatal follow-up is vital for developing effective compliance strategies.
- Removing identified barriers to family participation is essential for increasing attendance rates.
- Adapting neonatal follow-up clinics to pandemic-related challenges can improve adherence and outcomes.
Background:
Attendance to neonatal follow-up programs presents a significant factor associated with positive long-term outcomes of high-risk infants. Strategies to maximize participation benefit not only future interventions' effectiveness but also healthcare systems and society. While a number of studies have focused on attrition or loss to follow-up, no studies have focused on the contributive risk factors to abstaining from neonatal follow-up programs specifically during the COVID-19 pandemic. This study aims to reveal the main factors linked to non-compliance in a neonatal follow-up program of a tertiary hospital.
Methods:
In this ambidirectional observational study, data from 1137 high-risk neonates who participated in a hospital follow-up program were collected (573 before and 564 after the COVID-19 pandemic). The study sample was grouped to three groups: G1 (N = 831), who maintained participation in the program; G2 (N = 196), who discontinued; and G3 (N = 110), who never visited the outpatient clinics. Data were obtained from the hospital's Systems Applications and Products (SAP) Software and a structured questionnaire, answered by parents of newborns either discontinuing (G2) or not attending (G3) the follow-up program through a telephone contact.
Results:
The most frequently reported reason for discontinuance before the pandemic onset was the parents' perception of no necessity to maintain participation (44.12%). During the COVID-19 pandemic, provider-related barriers to maintaining hospital access, inability to provide high-quality services (37.14%), and feelings of fear and insecurity (18.5%) emerged as factors for non-attendance. Citizenship and morbidity (respiratory distress syndrome, sepsis, necrotic enterocolitis, jaundice) acted as incentives to join the follow-up program during both study periods. Multiple regression analysis showed that multiple-gestation infants had higher odds of maintaining participation during the COVID-19 period (OR, 4.04; CI, 1.09-14.9).
Conclusions:
Understanding the potential impact of COVID-19 and the transformative changes in neonatal follow-up clinics is crucial for applying compliance strategies. Removing barriers to maintain family participation can lead to increased attendance rates.
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