Impoverished Patients Skipping Their Follow-Up Visits

Subject: Public Health
Pages: 3
Words: 764
Reading time:
3 min
Study level: College


At my practicum site, the East Orange Hospital Clinic, which has recently been renamed the CareWell Health Medical Center, the problem of skipped follow-up visits encountered among impoverished patients. A significant part of the clients represents this population; thus, the lack of attendance severely influences the outcomes and quality of healthcare services (Ofei-Dodoo et al., 2019). The intervention development and implementation to address the problem became my practicum project.

After researching the impoverished population and exploring their perception of healthcare, values, and opportunities, the preceptor and I concluded that the most efficient way to make significant change is to influence the patients’ behavior through communication, education, and notification. Indeed, we revealed that the clients skip the appointments because attending a follow-up is costly, perceived as unnecessary, and frequently forgotten by the identified population. The practitioners, physicians, and administrators team was built to make a workable intervention (Dang et al., 2021). Our central objective was to decrease the number of skipped follow-up visits by at least 50% in three months and improve patient education practices. We achieved the goal as the non-attendance declined, and 75% of clients returned to the additional appointments.

Intervention Results

Our intervention based on interaction included communicating with patients to understand and address what prevents them from attending the hospital as per recommendations, educating them about the importance of follow-up visits, and additional notifications through WhatsApp. The team worked well in addressing their specific roles in the project, and the impoverished clients changed their behavior (Dang et al., 2021). Although the number of patients who were assigned to a follow-up visit is not equal from month to month, we registered and tracked each client to identify if they attended the additional consultation or not. We also calculated the number of patients and skipped visits for three months before the intervention to make conclusions. Three months before the intervention, 546 clients were assigned to the follow-up visits, and each month, the percentage of skipping increased by 15-25%. In the three months of intervention, 75% of 627 registered patients attended the additional appointment.

Lessons Learned

The team got through speed bumps and learned multiple lessons throughout the intervention, and was forced to adjust the initial strategy to overcome the challenges. For instance, the legal aspect of using clients’ data to notify them through WhatsApp and email was missed. We created a consent to sign and continue using these ways of contacting patients only if they agreed to share their data with a third party. Moreover, we had to reconsider selected strategies and adjust them to the impoverished population’s needs because each client’s experience is unique and cannot be addressed by a pre-written protocol (Ofei-Dodoo et al., 2019). The initial plan to follow patient education and communication scenarios was revised, and the stakeholders developed a conversation template to use instead. The initial strategy contained excellent practices as well, as we learned that the feedback gathering and discussion we performed weekly became a valuable source of data and an engaging team-building method. Maintaining a solid data collection strategy and being open to feedback is vital for the intervention to stay efficient.

How Leadership Impacted the Intervention

Building an intervention and sustaining its translation to a normal practice depends on the team’s willingness to provide better healthcare service to their beneficiaries. As a leader, I aimed to maintain strong motivation in the group and provide the stakeholders with sufficient space to make their contributions. Since many of my colleagues are older and more experienced than me, I found it inappropriate to use the authoritarian leadership style. Rather, transformational and participative ones became a priority as they respected the team members’ decision-making approaches (Välimäki et al., 2018). Practitioners and physicians adjusted the initial strategy to address the client’s specific needs and improve communication and education to convince them about the importance of follow-up visits.


The intervention to influence impoverished patients’ behavior toward attending follow-up visits was successfully implemented in the East Orange Hospital Clinic, decreasing the number of skipped appointments by 75%. Now the team works on transitioning the intervention’s activities into practice to make the results sustainable and eliminate the missed follow-up visits issue (White et al., 2021). For instance, the additional patient education about the importance of attending all appointments with arguments based on the client’s specific health conditions became a substantial part of physicians’ consultations. Furthermore, the external problems, such as transportation and insurance costs, were identified, and now we work on reaching policymakers, administration, and boards to propose a solution to a problem a massive part of the local population experiences.