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Top Ten Reasons Why Patients Are Lost To Care

15th Texas HIV/STD Conference December 11-15, 2006 Renaissance Austin Hotel Austin, Texas. Top Ten Reasons Why Patients Are Lost To Care. J4 - Texas/Oklahoma AIDS Education & Training Center Border Issues Track: . Tom Emanuele, Carlos Cuellar, Jose Sanchez Parkland Health & Hospital System

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Top Ten Reasons Why Patients Are Lost To Care

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  1. 15th Texas HIV/STD ConferenceDecember 11-15, 2006Renaissance Austin HotelAustin, Texas Top Ten Reasons Why PatientsAre Lost To Care J4 - Texas/Oklahoma AIDS Education & Training Center Border Issues Track: Tom Emanuele, Carlos Cuellar, Jose Sanchez Parkland Health & Hospital System HIV Services Dallas, Texas

  2. Objectives • Provide information to program planners to help develop strategies and services for retaining patients in care • Discuss barriers to care and help understand the reasons that patients drop out of care • Discuss the top ten reasons given by patients for leaving HIV primary care

  3. Lost to Care Program The Beginning Program initiated - 2001 Purpose: to track, locate and return to medical care patients who had stopped coming to clinic

  4. Lost to Care Program February 2001 - January 2006 Total Unduplicated Patients 3596 Total Contacts 11,562 Deceased 319 Total Patients Returned to Care 1628

  5. Lost to Care Program The Method Patient Identification Patients’ last PCP Visit was: Then >12 months Now > 6 months Demographic information list Medical Record Search Database Search

  6. Lost to Care Database Search HIV Case Management Database EPIC Database (Hospital mainframe Computer System) Social Security Death Index Database http://ssdi.genealogy.rootsweb.com Medical Examiners Office (every county has one)

  7. Lost to care Contact Attempts: Contact Methods: Telephone Letter CPIU (UTSW Collaboration)

  8. Lost to care Successful vs. Unsuccessful Attempts Assist successful contacts with re-entry in to medical care Unsuccessful contacts are referred to Community Prevention and Intervention Unit (CPIU) for follow-up

  9. Lost to Care Top 10 Reasons

  10. Lost to Care #10 Transferred Care to Another Facility • Patient obtains insurance and chooses a private provider • Current insurance is out of network • Not eligible for Parkland Community Health Plan • Finds medical care closer to home • COPC • Private Doctor • Free Community Clinic Top 10 Reasons

  11. Lost to Care #9 Patient Has Moved Out Of Area • To be closer to family or support system • Forgot to notify clinic that they have moved • Move frequently / mobile population Top 10 Reasons

  12. Lost to Care #8 Patient has expired • Clinic not always notified of death • Do preliminary searches first to prevent upsetting family and significant others • Search SSDI Database and contact Medical Examiner’s Office first Top 10 Reasons

  13. Lost to Care #7 Hospital or Rehab Program Admission • Due to non-compliance or substance use issues, patient requires admission • Substantial percentage of patients have substance use issues Top 10 Reasons

  14. Lost to Care #6 Incarceration • Substance use issues may lead to incarceration • Psychological Issues Top 10 Reasons

  15. Lost to Care #5 “Clinic visits take too long” • Dwell time to see provider too long • Wait time for discharge too long • Clinic visits cuts in to “me time!” Top 10 Reasons

  16. Lost to Care #4 Patient Dislikes Staff • Patient dislikes the medical provider • Patient dislikes Nurse • Patient dislikes clerical staff Top 10 Reasons

  17. Lost to Care #3 Unable To Get Time Off From Work • Patient afraid that employer will find out of diagnosis • Patient afraid of losing job and livelihood • Cannot afford unpaid days off Top 10 Reasons

  18. Lost to Care #2 Patient Unaware Of Appointment • Patient did not wait to get properly discharged • Incorrect mailing address on file • Incorrect phone number • No Telephone / Unable to contact patient • Patient never calls clinic to check about • appointments • Patient doesn’t want calls/contacts from clinic Top 10 Reasons

  19. Lost to Care #1 Patient Feels Fine • Patient feels well and doesn’t need to see a Doctor • Seeks medical care only when absolutely necessary • Patient tired of illness and doesn’t want to deal with it anymore • Clinic visits inconvenient and depressing Top 10 Reasons

  20. Lost to Care Program Conclusion Desired Outcomes... • Successful F/U and re-entry into medical care of Lost to Care Population • Facilitate patient to achieve improved physical, economic, social and emotional well-being • Improved access to and adherence to HAART • Return patients to care at earlier stage of disease leading to better outcomes • Conserve resources, decrease Emergency Department visits and decreased hospitalizations ($$$$$$$$)

  21. Lost to Care Program Better access to available support services. Clients are helped in overcoming fears, misconceptions, frustrations with system, and financial issues. Many clients express an appreciation for the personal contact and encouragement they have received.

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