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Practicum hours completion helps practitioners explore how their site operates in terms of internal processes and approaches to fulfill their clients’ requests. An AGNP can notice practice gaps that decrease the quality of health care and require to be addressed by the leaders of the organization (Dang et al., 2021). My practicum site, the East Orange General Hospital Clinic, has beneficiaries with various socioeconomic statuses and needs. My preceptor has recently been concerned about the growing number of follow-up appointments missed, mainly by the impoverished population representatives. The lack of timely attendance is a critical practice gap as the consequences damage the effectiveness of treatment, cause an additional burden on the industry, and make the patients worsen their conditions. This paper aims to discuss the question of why patients do not return to the clinic for their follow-up appointment and explore how this practice gap can be addressed in the East Orange General Hospital.
Follow-up appointments are the standard practice for most practitioners and physicians as it allows them to ensure a patient’s conditions improve and the prescribed treatment is effective. However, the clients might not return, and the increasing number of missed visits signals an organization that there is a practice gap or issue to address. In the East Orange General Hospital, the majority of patients who ignored follow-ups represent the impoverished population; thus, the problem might be related to the services provided to them. Indeed, the issue might occur due to clients’ inability to make time for it, afford the visit due to the insurance and transportation costs (Arpey et al., 2017). Furthermore, a practitioner might fail to emphasize the importance of the follow-up appointment or a clear explanation of when the patient needs a re-visit. The issue is frequent in the health care sector, and in my practicum site, it is specific to the impoverished population.
The problem of patients not returning to clinics for their follow-up appointment has been addressed in the literature as multiple studies have been conducted to identify the causes and develop the solutions. For instance, Williamson et al. researched the administrative data about repeated non-attendance and revealed that lack of education, wrong priorities, social vulnerability, and expenses are principal reasons to miss appointments (Williamson et al., 2017). Moreover, Ofei-Dodoo et al. conducted a qualitative evaluation of the issue and discovered that employment and family obligations, costly transportation, and long clinic wait times prevent diverse populations’ representatives from re-attending a hospital (Ofei-Dodoo et al., 2019). Literature suggests that the reasons why patients refuse to return can be addressed by filling the gaps in practice.
Practitioners and physicians can make management updates in the East Orange General Hospital to impact the number of non-attended follow-up visits. My preceptor recommended that the practitioners describe this low engagement with health care services as harmful behavior, encouraging the patients to avoid it and complete their treatment with all appointments (Williamson et al., 2021). The impoverished population can lack education or perceive the need for re-attending the hospital as an expensive experience (Arpey et al., 2017). Thus, physicians should clearly explain the consequences of missing a follow-up to make a client understand that the procedure is worth prioritizing and spending money on. Clinical office managers can practice phone or messaging reminders for patients with severe or chronic conditions to ensure they do not forget about their visit and provide them with all necessary information.
The question of why patients do not return to the clinic for their follow-up appointment is crucial to be addressed in a clinic to identify the practice gaps and avoid decreasing the quality of care. Patients with lower socioeconomic status are at the specific risk of facing the consequences as they have financial, obligatory, and hospital services-related reasons for non-attendance. My practicum site, the East Orange General Hospital, is concerned about the missed follow-up appointments and included management decisions such as specific attention to patient education and phone reminders.
References
Arpey, N. C., Gaglioti, A. H., & Rosenbaum, M. E. (2017). How socioeconomic status affects patient perceptions of health care: a qualitative study. Journal of Primary Care & Community Health, 8(3), 169-175. Web.
Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
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., Ellis, D. A., Wilson, P., McQueenie, R., & McConnachie, A. (2017). Understanding repeated non-attendance in health services: A pilot analysis of administrative data and full study protocol for a national retrospective cohort. BMJ Open, 7(2), e014120. 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.
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