Why Do Children With Traumatic Brain Injuries Miss Follow-up Appointments? Caregiver-perceived Barriers To Return For Follow-up
*Jin Peng, Kimberly Lever, *Sarah Caupp, *Krista K Wheeler, *Henry Xiang
Nationwide Children's Hospital, Columbus, OH
BACKGROUND: To examine caregiver-perceived barriers to return for follow-up appointments in children with traumatic brain injuries (TBI).
METHODS: At a level I pediatric trauma center,we queried the trauma registry to identify inpatient discharged children with TBI (2–18 years old) in 2014–2015. We then conducted chart reviews to abstract patient contact information and identify patient adherence with follow-up appointments. We mailed a self-report paper survey to families of eligible patients. Outcomes were follow-up barriers reported by caregivers. Multivariable logistic regression was used to identify caregiver characteristics associated with reporting a certain barrier.
RESULTS: Almost half of children with TBIs missed appointments. Among the 395 families to whom we sent survey invites, 296 did not opt out (Figure 1) and received the survey. Of these, 145 completed the survey. The top three reported barriers were “no need” (40%), “schedule conflicts” (15%), and “lack of resources” (10%). Other barriers included long drive distance, no reminders, inconvenient appointment time, and forgetting. Female caregivers were less likely to report “no need” as a barrier (OR=0.22, 95% CI: 0.06–0.85). Caregivers with an associate’s degree or above were less likely to report “lack of resources” as a barrier (OR=0.23, 95% CI: 0.06–0.91).
CONCLUSIONS: The top three reported barriers were “no need,” “schedule conflicts,” and “lack of resources.” To improve TBI follow-up adherence, providers may need to educate families, coordinate appointments, and provide enabling resources.
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