Advertisement

Who Will Show? Predicting Missed Visits Among Patients in Routine HIV Primary Care in the United States

  • Brian W. Pence
  • Angela M. Bengtson
  • Stephen Boswell
  • Katerina A. Christopoulos
  • Heidi M. Crane
  • Elvin Geng
  • Jeanne C. Keruly
  • W. Christopher Mathews
  • Michael J. Mugavero
Original Paper

Abstract

Missed HIV medical visits predict poor clinical outcomes. We sought to identify patients at high risk of missing visits. We analyzed 2002–2014 data from six large US HIV clinics. At each visit, we predicted the likelihood of missing the next scheduled visit using demographic, clinical, and patient-reported psychosocial variables. Overall, 10,374 participants contributed 105,628 HIV visits. For 17% of visits, the next scheduled appointment was missed. The strongest predictor of a future missed visit was past-year missed visits. A model with only this predictor had area under the receiver operator curve = 0.65; defining “high risk” as those with any past-year missed visits had 73% sensitivity and 51% specificity in correctly identifying a future missed visit. Inclusion of other clinical and psychosocial predictors only slightly improved performance. Past visit attendance can identify those at increased risk for future missed visits, allowing for proactive allocation of resources to those at greatest risk.

Keywords

HIV Retention in care Missed visits Appointment attendance Predictive models 

Notes

Acknowledgements

BWP, SB, KC, HMC, EG, WCM, and MJM contributed to the acquisition of the data; BWP designed the analysis; BWP and MJM drafted the manuscript; BWP, AMB, SB, KC, SRC, HMC, EG, JK, WCM, and MJM assisted with the interpretation of the data and critically revised the manuscript for important intellectual content. All authors take responsibility for and approve the final version of the manuscript. We thank the National Institutes of Mental Health [Grant Number R01MH100970] and the National Institute of Allergy and Infectious Diseases [Grant Numbers R24AI067039 and P30 AI50410] for their support of this work.

Funding

This work was supported by the National Institutes of Mental Health [Grant Number R01MH100970 to BWP] and by the National Institute of Allergy and Infectious Disease [Grant Numbers R24AI067039, P30AI50410].

Compliance with Ethical Standards

Conflict of interest

BWP has received a speaking honorarium from MSD. KAC has been a scientific advisory board member for Roche and a community advisory board member for Gilead.

Supplementary material

10461_2018_2215_MOESM1_ESM.docx (80 kb)
Supplementary material 1 (DOCX 79 kb)

References

  1. 1.
    Bradley H, Hall HI, Wolitski RJ, et al. Vital signs: HIV diagnosis, care, and treatment among persons living with HIV–United States, 2011. MMWR Morb Mortal Wkly Rep. 2014;63(47):1113–7.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Skarbinski J, Rosenberg E, Paz-Bailey G, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588–96.CrossRefPubMedGoogle Scholar
  3. 3.
    Mugavero MJ, Davila JA, Nevin CR, Giordano TP. From access to engagement: measuring retention in outpatient HIV clinical care. AIDS Patient Care STDs. 2010;24(10):607–13.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Mugavero MJ, Westfall AO, Zinski A, et al. Measuring retention in HIV care: the elusive gold standard. J Acquir Immune Defic Syndr. 2012;61(5):574–80.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Mugavero MJ, Lin HY, Willig JH, et al. Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis. 2009;48(2):248–56.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Mugavero MJ, Westfall AO, Cole SR, et al. Beyond core indicators of retention in HIV care: missed clinic visits are independently associated with all-cause mortality. Clin Infect Dis. 2014;59(10):1471–9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kitahata MM, Rodriguez B, Haubrich R, et al. Cohort profile: the centers for AIDS research network of integrated clinical systems. Int J Epidemiol. 2008;37(5):948–55.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282(18):1737–44.CrossRefPubMedGoogle Scholar
  10. 10.
    Bradley KA, Bush KR, Epler AJ, et al. Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Arch Intern Med. 2003;163(7):821–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–95.CrossRefPubMedGoogle Scholar
  12. 12.
    Newcombe DA, Humeniuk RE, Ali R. Validation of the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): report of results from the Australian site. Drug Alcohol Rev. 2005;24(3):217–26.CrossRefPubMedGoogle Scholar
  13. 13.
    WHO Assist Working Group. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction. 2002;97(9):1183–94.CrossRefGoogle Scholar
  14. 14.
    Chesney MA, Ickovics JR, Chambers DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care. 2000;12(3):255–66.CrossRefPubMedGoogle Scholar
  15. 15.
    Amico KR, Fisher WA, Cornman DH, et al. Visual analog scale of ART adherence: association with 3-day self-report and adherence barriers. J Acquir Immune Defic Syndr. 2006;42(4):455–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Melnikow J, Kiefe C. Patient compliance and medical research: issues in methodology. J Gen Intern Med. 1994;9(2):96–105.CrossRefPubMedGoogle Scholar
  17. 17.
    Martin S. 98% of HBR Readers Love This Article: businesses are just beginning to understand the power of “social norms”. Harv Bus Rev. 2012;90(10):23–5.Google Scholar
  18. 18.
    Steyerberg EW, Harrell FE Jr, Borsboom GJ, Eijkemans MJ, Vergouwe Y, Habbema JD. Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol. 2001;54(8):774–81.CrossRefPubMedGoogle Scholar
  19. 19.
    Gardner LI, Marks G, Craw JA, et al. A low-effort, clinic-wide intervention improves attendance for HIV primary care. Clin Infect Dis. 2012;55(8):1124–34.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Gardner LI, Giordano TP, Marks G, et al. Enhanced personal contact with HIV patients improves retention in primary care: a randomized trial in 6 US HIV clinics. Clin Infect Dis. 2014;59(5):725–34.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis. 2013;57(8):1164–71.CrossRefPubMedGoogle Scholar
  22. 22.
    Thompson MA, Mugavero MJ, Amico KR, et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an international association of physicians in AIDS care panel. Ann Intern Med. 2012;156(11):817–33.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Giordano TP, Gifford AL, White AC, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Bofill L, Waldrop-Valverde D, Metsch L, Pereyra M, Kolber MA. Demographic and psychosocial factors associated with appointment attendance among HIV-positive outpatients. AIDS Care. 2011;23(10):1219–25.CrossRefPubMedGoogle Scholar
  25. 25.
    Nijhawan AE, Liang Y, Vysyaraju K, et al. Missed initial medical visits: predictors, timing, and implications for retention in HIV care. AIDS Patient Care STDs. 2017;31(5):213–21.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Traeger L, O’Cleirigh C, Skeer MR, Mayer KH, Safren SA. Risk factors for missed HIV primary care visits among men who have sex with men. J Behav Med. 2012;35(5):548–56.CrossRefPubMedGoogle Scholar
  27. 27.
    Fleishman JA, Yehia BR, Moore RD, Korthuis PT, Gebo KA. Establishment, retention, and loss to follow-up in outpatient HIV care. J Acquir Immune Defic Syndr. 2012;60(3):249–59.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Brian W. Pence
    • 1
  • Angela M. Bengtson
    • 2
  • Stephen Boswell
    • 3
  • Katerina A. Christopoulos
    • 4
  • Heidi M. Crane
    • 5
  • Elvin Geng
    • 4
  • Jeanne C. Keruly
    • 6
  • W. Christopher Mathews
    • 7
  • Michael J. Mugavero
    • 8
  1. 1.Department of Epidemiology, Gillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of EpidemiologyBrown UniversityProvidenceUSA
  3. 3.Fenway HealthBostonUSA
  4. 4.Division of HIV, ID and Global Medicine, Zuckerberg San Francisco General HospitalUniversity of California San FranciscoSan FranciscoUSA
  5. 5.Department of Medicine, School of MedicineUniversity of WashingtonSeattleUSA
  6. 6.Department of Medicine, School of MedicineJohns Hopkins UniversityBaltimoreUSA
  7. 7.Department of Medicine, School of MedicineUniversity of California, San DiegoSan DiegoUSA
  8. 8.Department of Medicine and UAB Center for AIDS ResearchUniversity of Alabama at BirminghamBirminghamUSA

Personalised recommendations