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The Difficulty Of Plastic Surgery Follow Up In A Safety Net Hospital
Peggy J. Ebner, MD, Dania Johnson, BS, Rachel Knapp, BS, Jack Rodman, MPH, T. Justin Gillenwater, MD, Haig Yenikomshian, MD.
University of Southern California, Los Angeles, CA, USA.
PURPOSE: Long term follow up and communication are paramount to recovery after reconstruction. Patients of lower socioeconomic status are at increased risk of missing follow up appointments or being unable to obtain care. The purpose of this study is to understand patients’ barriers to follow up and determine their preferred methods of communication.
METHODS: Patients attending a reconstructive plastic and burn surgery outpatient clinic at a major safety net hospital were queried over a 1-year period. Questions included preferences for hospital communication and barriers to follow up. Associations between variables were assessed using Pearson’s chi-squared or Fisher’s exact test, as appropriate.
RESULTS: A total of 301 participants were surveyed. Demographics included 72% Hispanic/Latino, 10% black, and 5% Asian. 40% were primary Spanish speakers. Patients most preferred contact by phone (62%) or text (67%). 20% of Hispanic/Latino patients had inconsistent access to the internet, compared to 8.7% of non-Hispanic patients (p=<0.001). 55% anticipated difficulty attending follow ups, most frequently citing difficulty with transportation (20.6%), trouble taking time off work (14%), or scheduling issues (11%). 10% stated that they did not think they would be able to attend even a single recommended follow up appointment.
CONCLUSION: Most patients anticipated difficulty attending follow up appointments due to various social and economic barriers. Access to the internet (a potential solution) varied by demographic. This project demonstrates the need to understand pressures on under-resourced patients and alter follow up protocols accordingly.
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