Objective:
Patients with hemophilia have been receiving comprehensive care at Hemophilia Treatment Centers (HTC) for the past 30 years which includes: annual medical and psychosocial assessments, training for home infusions of factor, physical therapy evaluations and treatment.
As many of our patients with Hemophilia now self -infuse, they require less visits to the HTC, Emergency Department and hospitalizations. We have noted over the past few years that many patients are delinquent in keeping yearly comprehensive visits. In an effort to increase attendance at comprehensive clinic, and introduce and assess the success of psychosocial interventions, on increasing compliance with appointments, a standard assessment form was created to identify reasons for non-attendance at comprehensive care visits.
Methods:
Data collection included characteristics of the household such as marital status and family size, last comprehensive re-evaluation and ages of patients (< 18 or >18 years). Assessment of barriers included: drug addiction, school related issues relating to academic success, value of comprehensive clinic during a non-emergent time, DYFS involvement, major psychosocial issues, transportation and work related issues such as financial concerns and concern for using days for non-emergent reasons.
Each identified patient was contacted by the social worker to assess reasons for non- compliance utilizing the standard assessment form. Following the assessment, the social worker created and implemented an individually tailored plan developing interventions and employing education, counseling and supportive services.
Summary:
A total of 26 patients were identified as delinquent in comprehensive care visits. Eight were pediatric patients and eighteen were adult patients. All identified patients were called and assessed for barriers to compliance with clinic visits. The major barrier identified was both parents’ and patients’ value of comprehensive clinic during a non-emergent time (46 % of patients). The second major barrier was work related issues (31% of noncompliance). Major psychosocial issues (15 %) and school issues (8 %) accounted for the remaining causes of non-compliance with clinic appointments. Individual plans to address barriers were made and implemented. Following the psychosocial intervention 46 % of the previously non- compliant patients made comprehensive clinic visits.
Conclusions:
Identification of psychosocial reasons for non-compliance to comprehensive care clinic with the development of individual plans to address needs lead to improved compliance with visits.