Improving Treatment Adherence for Veterans with Coronary Artery Disease
Given that patients' missed appointments pose problems for both patients and providers, extensive research has focused on identifying factors associated with missed appointments; however, almost none have focused on patients who miss appointments for testing or treatment for coronary artery disease (CAD). This study examines whether patient characteristics (e.g., sociodemographics) and/or clinic features (e.g., time to appointment) are associated with missed appointments among veterans scheduled for CAD diagnostic testing, and who receive primary care through the VA healthcare system. Investigators analyzed patient interview and other data for 379 veterans who had a scheduled appointment for cardiac testing (invasive and/or non-invasive) at one VAMC.
Findings show that nearly 40% of the veterans did not keep their appointments, indicating that non-attendance in this particular patient population is a significant problem. Several factors associated with non-attendance were: slightly younger age, lower income, unemployment, and longer wait times for appointments (136 vs. 54 days for non-attenders compared to attenders). Veterans who missed appointments also reported fewer cardiac symptoms and were more likely to attribute them to something other than heart disease. Other reasons given for non-attendance were fear of diagnostic procedures (22.3%), as well as dissatisfaction with VA care and lack of trust in the physicians or hospital (16.5%). Authors suggest that these factors be considered when designing clinical systems to reduce missed appointments, and that future work explore the long-term health impact on veterans with missed CAD diagnostic appointments.
Siminoff L, Hausmann L, and Ibrahim S. Barriers to obtaining diagnostic testing for coronary artery disease among veterans. American Journal of Public Health December 2008;98(12):2207-2213.
This study was funded through HSR&D. Dr. Siminoff is part of the Louis Stokes VA Medical Center. Drs. Hausmann and Ibrahim are part of HSR&D's Center for Health Equity Research and Promotion, in Pittsburgh.