Ellen DiNardo

Reasons for nonattendance for the treatment of venous ulcers in an inner-city clinic

Purpose This study examined the reasons that people attending an inner‐city wound clinic gave for missing appointments and compared these reasons with those of people who did not have chronic wounds. Methods Thirty‐six patients with venous ulcers and 115 people without leg ulcers responded to a survey that queried the reasons for missing clinic appointments. Consecutive sampling was used to obtain participants. The Clinic Attendance Questionnaire was developed for the study and consisted of a demographic section and the Reasons for Nonattendance Questionnaire, which has 45 Yes/No items. Items in the Reasons for Nonattendance Questionnaire were sorted by the investigators into 5 subscores (Personal, Clinic Problem, Illness, Mental Health, and Social). Questionnaires were read to participants. Data were not collected from patients who kept all appointments or from new patients. Results The primary reasons that patients seeking wound care gave for missing appointments were no ride, no money, out of town, forgot, and in too much pain. People with leg ulcers had significantly more Social, Illness, Personal, and Total reasons, but fewer Clinic Problem reasons, for missing appointments than did the people without leg ulcers. The two groups did not differ in their rating of health, importance of health, or age. Most of the people with leg ulcers had a history of illicit drug abuse. Conclusions Nonattendance for clinic appointments may delay healing of venous ulcers and decrease the efficiency of the clinic. Reasons for missing wound clinic appointments are numerous and may vary with the patients condition and background.

Pearls for Practice. Reasons for Missing Appointments in an Outpatient Clinic for Indigent Adults

Missed appointments pose many problems for both patients and clinic personnel. Patients who miss appointments may not be correctly diagnosed or may not receive the proper treatment; therefore, therapeutic effectiveness is decreased (Hermoni, Mankuta, & Reis, 1990; Kane, 1991). Failure to keep appointments also impacts the administration of the clinic by increasing the waiting time for appointments for other patients, decreasing the efficiency of the clinic, increasing costs, interfering with swing , and decreasing staff satisfaction (Hermoni et al., 1990; Kane, 1991; Turner & Cooke, 1991). The purpose of this study was to examine reasons adults gave for missing clinic appointments and to compare these reasons to demographic and selected diagnostic variables, specifically hypertension, diabetes mellitus, and chronic pain.

The prevalence of pain and its association with psychosocial factors for indigent adults enrolled in a primary care clinic.

Objectives:Pain is a symptom reported in 50% to 70% of primary care visits and negatively impacts both physical and psychological functioning. People at risk of receiving inadequate management of pain include the indigent and people of color. The purpose of this exploratory, descriptive, cross-sectional study was to describe the prevalence of pain and its relation to functional status, depressive symptoms, perception of control over pain and coping in an urban, primary care clinic for indigent adults. Methods:Individuals (N=301) attending a primary care clinic for indigent adults were surveyed. Patients were 22 to 64 years of age, experienced pain during the past 2 weeks, and were able to understand and respond in English. Results:Ninety-two percent of the sample was African American and the average worst pain score was 8.4/10. The majority of patients had depression symptoms (77%), with pain most affecting patients’ function with sleep, ability to work, and walking. Patients reporting higher pain scores had significantly lower perception of control over pain and reduced control over life in general. Higher reported pain levels were also significantly correlated with higher catastrophizing, depressive symptoms, and interference with function scores. Discussion:Pain levels were reported as high and affected psychological and physical functioning. This study was unique in the high percentage of African American participants and being conducted in a primary care clinic for indigent adults. Greater understanding of this population’s pain will assist clinicians to assess pain comprehensively, provide education, and make treatment decisions for these patients.

Psychometric Properties and Construct Validity of the Knowledge Information Profile–Coumadin

Background: Oral anticoagulation therapy using Coumadin (warfarin) requires significant patient involvement. Limited validated instruments exist to test patient knowledge of Coumadin, and low health literacy may impede patient self-management. Objective: This article reports the psychometric testing of the Knowledge Information Profile–Coumadin (KIP-C20) to determine (a) minimum number of items and dimensions, (b) reliability, and (c) construct validity. Methods: Participants (N = 192) were recruited from outpatient pharmacist-directed anticoagulation clinics associated with an urban teaching hospital in the Midwest United States. Instruments were the Animal Naming test (AN), Rapid Estimate of Adult Literacy in Medicine (REALM), and KIP-C20. Multidimensional item response theory modeling and exploratory factor analyses were used to determine the best fitting model. Results: The final instrument, renamed KIP-C14, with 3 factors and 14 items, had a good fit to data (M2 = 96.49, P < .0001; root mean square error of approximation = .04), and all factor loadings were .3 or larger. Internal consistency reliability was .65; test–retest correlation was .67. The KIP-C14 correlated positively, as expected, with years of Coumadin treatment. Subscales were differentially correlated with sociodemographic variables. Conclusions: The KIP-C14 had nearly identical, slightly higher reliability than the KIP-C20. Still, reliability was lower than expected, indicating a promising clinical assessment scale in need of further refinement.

Wound-Psychosocial and Quality of Life Aspects: 3401

a static air mattress overlay and static air seat cushion on all patients admitted to our surgical hospital unit would decrease the incidence of hospital-acquired pressure ulcers. We used crosssectional data collection using the National Database of Nursing Quality Indicators (NDNQI). The target population was inpatients located on the surgical unit of our hospital and excluded any patient that was not on a static air mattress overlay during their entire inpatient hospital stay. The study compared a one-day snapshot survey of patients with standard ulcer prevention strategies before usage of static air mattress and seat cushion and a oneday snapshot survey after usage of a static air mattress overlay and static air seat cushion, education for the patient, families and nursing staff. We discovered that the percentage of our surgical patients with hospital-acquired pressure ulcers (HPU) for the quarter prior to the research study was 18.18%. The percentage of our surgical patients during the research study was 4.76%. The patients that developed a HPU during our study had been previously excluded from the research study because they were not on a mattress overlay during their entire inpatient stay. We concluded that the use of a static air mattress overlay and static air seat cushion, when used on all patients admitted to our surgical unit along with education for the patient, families and staff resulted in positive patient outcomes as demonstrated by the significant reduction in hospital-acquired pressure ulcers.