The practicum experience is crucial for AGNPs who are willing to improve their skills and address the current health care issues through implementing novel work strategies or identifying and resolving the gaps. Indeed, my site, the East Orange General Hospital Clinic, has various populations as clients and specific problems exist in serving them. I discovered the growing number of follow-up appointments missed, mainly by the impoverished population representatives. This significant gap in practice required evidence-based analysis and activities implementation to be addressed, and the outcomes align with my objectives of problem-solving, communication, and help for society. Furthermore, missed follow-ups worsen the effectiveness of treatment, making additional financial burdens if the patient’s conditions worsen (Arpey et al., 2017). The practice-focused question in the PICO format can be “In impoverished patients, what is the efficiency of treatment if they refuse to attend follow-ups, compared with ones who had a timely return visit?” This paper aims to discuss the problem of missed appointments and identify the purpose of resolving it in East Orange General Hospital Clinic as a practicum setting.
Follow-up appointments are critical because they evaluate if the additional treatment is necessary, adjust the current prescriptions, or consulate a patient on prevention or conditions’ maintenance. Furthermore, return visits help physicians assess the effectiveness of their practices, and therefore influence the quality of care a clinic offers (Dang et al., 2021). However, the tendency to miss follow-up appointments exists among the lower socio-economic status representatives because it is perceived as an event that is not worth the expenses.
In my practicum site, the impoverished populations are a significant part of beneficiaries, and more than a quarter of them skips the follow-up. Furthermore, literature reviews indicated that the average rate of missed return visits is 23%, and the number continues to grow, damaging the healthcare industry’s performance and affecting chronic diseases and mortality nationwide (Dantas et al., 2018). The lack of attendance might occur due to clients’ forgetfulness, language barrier, insufficient funds for transformation, lack of education, and understanding of follow-ups’ importance are the main reasons for skipping a visit. The practice-focused question requires studying what affects patients’ willingness to make return visits and how physicians and practitioners can impact their decision-making.
The practice gap was identified at East Orange General Hospital Clinic when my preceptor noticed that more than 25 patients did not return for a follow-up visit within three days, and most of them represent the impoverished beneficiaries. The challenge is crucial to be addressed because the lack of an action plan and evidence-based strategies can lead the organization to more complex issues such as the increased prevalence of chronic diseases (Agency for Healthcare Research and Quality, 2017). Shrestha et al. (2017) state that “missed clinic appointments reduce clinic efficiency, waste resources, and increase costs; limited data exist on subspecialty clinic attendance” (p. 436). Consequently, the purpose of exploring and responding to the identified practice-based question is to develop workable tactics to convince the impoverished patients to make return follow-up visits.
The practical question in the PICO format enables a practitioner to assess the efficiency of treatment applied to the impoverished population in the cases when they attend the follow-up and when their visit is missed. The retrieved evidence combined with the literature review can identify why patients refuse to return, and an actionable plan can then be developed. Common factors and barriers that influence the clients’ decision-making, such as language barriers, lack of knowledge, or wrong priorities, must be analyzed to understand how to eliminate the practice. In my clinical site, physicians and practitioners can improve the attendance rates through active participation and communicational strategies’ implementation.
Agency for Healthcare Research and Quality. (2017). Action plan for translating research into practice: Gap analysis and tests of change. Web.
Arpey, N. C., Gaglioti, A. H., & Rosenbaum, M. E. (2017). How socio-economic status affects patient perceptions of health care: a qualitative study. Journal of Primary Care & Community Health, 8(3), 169-175. Web.
Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
Dantas, L. F., Fleck, J. L., Oliveira, F. L. C., & Hamacher, S. (2018). No-shows in appointment scheduling–a systematic literature review. Health Policy, 122(4), 412-421. Web.
Shrestha, M. P., Hu, C., & Taleban, S. (2017). Appointment wait time, primary care provider status, and patient demographics are associated with nonattendance at outpatient gastroenterology clinic. Journal of Clinical Gastroenterology, 51(5), 433-438. Web.