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Where is the patient? The association of psychosocial factors and missed primary care appointments in patients with diabetes.

Abstract：

OBJECTIVE:Missed appointments are associated with poorer health outcomes. We predicted that compared to secure attachment style, fearful and dismissing attachment styles would be associated with greater number of missed primary care visits in patients with diabetes. METHODS:In patients with diabetes from nine health maintenance organization primary care clinics, we collected data on attachment style and major depression status, and determined the number of missed primary care appointments from automated data. We used Poisson and logistic regression analyses to determine if attachment style was associated with the number of missed primary care same day appointments, scheduled office visits and scheduled preventive care visits, after adjusting for demographics, clinical characteristics, appointment frequency and clustering by clinic. We included major depression as a potential effect modifier. RESULTS:Among 3,923 patients with diabetes, prevalence rates of attachment styles were 43.9% for secure, 35.8% for dismissing, 8.1% for preoccupied and 12.2% for fearful attachment style. Major depression was present in 12.4% of patients. Among patients without major depression, there were more missed scheduled office visits (RR=1.46, 95% CI=1.18-1.81) among those with dismissing compared to secure attachment style. The likelihood of having missed same day appointments was lower for those with fearful attachment style relative to those with secure attachment style in nondepressed patients compared to patients with fearful and secure attachment style with major depression (P < .01). CONCLUSIONS:Attachment styles characterized by low levels of collaboration are associated with more missed primary care appointments compared to secure attachment style in patients with diabetes. These associations are moderated by depression status.

journal_name

Gen Hosp Psychiatry

journal_title

General hospital psychiatry

authors

Ciechanowski P,Russo J,Katon W,Simon G,Ludman E,Von Korff M,Young B,Lin E

doi

10.1016/j.genhosppsych.2005.07.004

subject

Has Abstract

pub_date

2006-01-01 00:00:00

pages

9-17

issue

eissn

0163-8343

issn

1873-7714

pii

S0163-8343(05)00120-9

journal_volume

pub_type

杂志文章,多中心研究

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Where is the patient? The association of psychosocial factors and missed primary care appointments in patients with diabetes.