Barriers to Attendance of Pediatric Patients to the Nephrology Clinic: a Single Center Study




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Purpose: No-shows are defined as when a patient does not attend their scheduled clinic appointment without prior notification. Studies have been conducted in other specialties to show the effect of no-shows on patient and clinic outcomes, however there is limited research surrounding non-attendance in the pediatric nephrology population. Kidney conditions not diagnosed promptly can lead to serious complications including kidney failure and the need for dialysis. Therefore, it is imperative patients attend appointments so these conditions can be properly diagnosed and treated. Our study aimed to identify barriers to attendance of these appointments in the pediatric nephrology population at Cook Children’s Medical Center. This quality improvement project will promote future research into other barriers as well as interventions to improve attendance to nephrology clinics. Methods: A retrospective chart review of pediatric nephrology patients referred to Cook Children’s outpatient nephrology clinics from August 1, 2018 to June 30, 2023 was conducted. Data collection was limited to: patients between 0-21 years old at time of missed appointment, new or established patients with at least one documented no-show, and patients who canceled and did not reschedule. Demographic data was collected from each patient. Data analysis composed of descriptive statistics and frequencies of independent variables. Study data was managed using REDCap (Research Electronic Data Capture) tools hosted at Cook Children’s. Results: Our study found significant associations between no-show/cancellation rates and certain variables. Males were 1.1 times more likely to no-show and cancel. Black/African-American patients were more likely to no-show and cancel than expected. Patients on public insurance were 1.6 times more likely to no-show. Patients older than 12 were more likely to no-show. Patients whose primary language was English were less likely to cancel. Established patients were 1.1 times more likely to cancel. Telemedicine patients were 1.5 times more likely to no-show and 1.4 times more likely to cancel. Conclusion: Our results echo similar studies in other specialties. Socioeconomic disparities and specific diagnoses may be an explanation for increased no-show/cancellation rates in certain groups. Addressing these inequities with interventions designed to ease patient accessibility can improve rates of retention and follow-up. Further studies are necessary to qualify our data and evaluate the effects of implementation measures.