Various issues reveal during the nursing practice, and new professionals can study them to achieve quality improvement. In the East Orange Hospital Clinic, most beneficiaries represent the impoverished population, and the problem of skipping the follow-up appointments has recently occurred. Indeed, more than 25% of patients did not attend the planned visit with their doctor during the last month. The issue is urgent because missing the follow-up harms the quality of services and increases the risk of clients’ conditions worsening. It is in the practitioner’s power to influence the situation and change patients’ behavior through practical interventions and policy updates (Williamson et al., 2021). This paper aims to discuss the problem of the increased number of skipped follow-up visits among the impoverished population and develop a related PICOT question.
The problem of skipped follow-ups is significant, and multiple reasons cause patients to non-attend their doctor after the initial visit. One of such factors is the socio-economic status of beneficiaries as it influences their priorities and healthcare insurance services affordability (Dantas et al., 2018). Indeed, employment and family obligations, costly transportation, and long clinic wait times prevent impoverished populations’ representatives from re-attending a hospital (Ofei-Dodoo et al., 2019). The problem is directly related to the practice because the services’ delivery impacts clients’ decision-making. For instance, patient education can include the practitioners’ describing the low engagement with healthcare recommendations as harmful behavior, encouraging the patients to avoid it and complete their treatment with all appointments (Williamson et al., 2021). Skipped follow-ups are severe for the organizations because they reduce efficiency, increase costs, and waste the previous treatment outcomes (Dantas et al., 2018). Consequently, the issue is essential to nursing practitioners because it determines the quality of their work and can dramatically damage the health outcomes of impoverished patients.
The problem of skipped follow-ups can be addressed to diverse clients; however, the practicum site’s beneficiaries mostly represent the low-income groups. Studying the literature and researching the impoverished population would be appropriate for developing the solutions. Such groups tend to prioritize saving finances and affording only the minimum of healthcare services even when their conditions require more complicated interventions (Ofei-Dodoo et al., 2019). Furthermore, the impoverished populations frequently have language barriers, lack sufficient education, and lead an unhealthy lifestyle.
Intervention for skipping follow-up visits must be based on the research about the population and include multiple influence channels simultaneously. Indeed, physicians can improve patient education through teaching how crucial it is to attend the appointment; administration can develop reminder practices. Nursing practitioners can also adjust their communication to tailor the importance of follow-up visits and ensure that the client understands. In comparison, another solution can be no actions taken on the practicum site’s workers, yet patients’ worsening conditions due to the skipped appointment can be explained as their responsibility. In such a case, the number of missing follow-up visits would also decrease as the clients will learn through the experience and share it with their friends and family.
The outcome is the decrease of the skipped follow-up visits by the impoverished populations, and it can be calculated through attendance tracking. The hospital operates through an electronic record system, and data to analyze would be retrieved from there. Timeframe to realize the initiative and achieve notable results depends on the number of follow-up visits assigned by physicians to their impoverished patients. The average period, such as three months, can be chosen for checking if the percentage of missed appointments changed.
The PICOT question is: “In impoverished patients, what is the efficiency of treatment if they are encouraged to attend the follow-up visit, compared to no intervention within three months?”
Dantas, L. F., Fleck, J. L., Oliveira, F. L. C., & Hamacher, S. (2018). No-shows in appointment scheduling–a systematic literature review. Health Policy, 122(4), 412-421. Web.
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Ofei-Dodoo, S., Kellerman, R., Hartpence, C., Mills, K., & Manlove, E. (2019). Why patients miss scheduled outpatient appointments at urban academic residency clinics: A qualitative evaluation. Kansas Journal of Medicine, 12(3), 57. Web.
Williamson, A. E., McQueenie, R., Ellis, D. A., McConnachie, A., & Wilson, P. (2021). ‘Missingness’ in health care: Associations between hospital utilization and missed appointments in general practice. A retrospective cohort study. PloS One, 16(6), e0253163. Web.