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Caregiver-Reported Barriers and Predictors of Appointment Attendance in Pediatric Craniofacial Team Care
Katherine Dillon1, Magdaline Kotsakis1, Colin Brady1
1Center for Craniofacial Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Insights
Caregiver-reported logistical challenges, not demographics, significantly impact pediatric craniofacial appointment attendance. Addressing care coordination barriers improves consistent attendance for children with craniofacial conditions.
Area of Science:
- Pediatric Healthcare
- Craniofacial Medicine
- Health Services Research
Background:
- Appointment attendance is crucial for effective management of pediatric craniofacial conditions.
- Identifying barriers to attendance is essential for optimizing patient care and outcomes.
Purpose of the Study:
- To determine caregiver-reported barriers affecting appointment attendance for pediatric craniofacial team visits.
- To identify demographic, clinical, and logistical predictors of missed visits.
Main Methods:
- A prospective, multimethod study involving 213 caregivers of patients attending a craniofacial outpatient clinic.
- Caregivers completed a questionnaire on attendance factors; medical records provided demographic and clinical data.
- Statistical analyses included descriptive statistics, chi-square/Fisher's exact tests, and multivariable logistic regression.
Main Results:
- Higher healthcare burden and multiple same-day appointments correlated with increased attendance.
- Syndromic diagnoses predicted higher attendance, while preferred appointment times predicted lower attendance.
- Demographic factors like race, ethnicity, and insurance status did not significantly predict attendance.
Conclusions:
- Logistical demands and care coordination are stronger predictors of attendance than demographic or clinical factors.
- Targeted support for modifiable barriers can improve consistent attendance in craniofacial care.
- Interventions should focus on practical challenges faced by families managing complex pediatric care.
Abstract:
ObjectiveTo identify caregiver-reported barriers influencing appointment attendance and evaluate demographic, clinical, and logistical predictors of missed pediatric craniofacial team visits.DesignProspective, multimethod study.SettingQuaternary pediatric craniofacial outpatient clinic.ParticipantsTwo hundred thirteen caregivers of patients scheduled for craniofacial team visits completed a 10-item questionnaire assessing factors that influence appointment attendance.Main Outcome MeasuresThe primary outcome was appointment attendance (attended vs. missed/canceled). Demographic and clinical variables were extracted from the medical record. Descriptive statistics were calculated. Chi-square or Fisher's exact tests assessed bivariate associations. A multivariable logistic regression model was used to identify predictors of attendance. Open-ended responses on missed visit reasons were analyzed thematically.ResultsFamilies managing a higher monthly healthcare burden were significantly more likely to attend scheduled appointments. Those with 4 or more health-related appointments (OR = 0.008, P < .001) had markedly lower odds of nonattendance. Similarly, families with other same-day appointments had significantly lower odds of nonattendance (OR = 0.154, P < .001). Children with syndromic diagnoses were also more likely to attend than their nonsyndromic peers (OR = 0.336, P = .045). Attendance was lower among families who reported receiving their preferred appointment time (OR = 0.11, P = .027). Demographic variables, including race, ethnicity, and insurance status, were not significant predictors of attendance.ConclusionsAppointment attendance appears to be more strongly influenced by logistical demands and care coordination than by demographic or clinical characteristics. Addressing these modifiable barriers through targeted supports may offer a more effective strategy for improving consistent attendance in craniofacial care.
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