The 4-Step Model of Follow-Up at the High-TR Clinics
| Steps | Selected quotes | Source/high- or low-TR clinic |
|---|---|---|
| Step I: Administrative staff prepares the “no show” list and contacts patients who did not proceed with recommended treatments | If they (patients) do not show for a week or two, we see their name on the “no show” list and call again. We do not give up. | Administrator/high-TR clinic |
| We ask for the report (no show list) and we can see who came and who did not. This huge job is done by the administrator. | PCP/high-TR clinic | |
| They (doctor and nurse) do not ask me to follow up with patients. The doctor is responsible and he follows. (Clinic Administrator) | Administrator/low-TR clinic | |
| The doctors are the ones who reach out to patients to explain to them. I can explain administrative things but that is it. (Clinic Administrator) | Administrator/low-TR clinic | |
| Step II: The nurse reaches out to patients who did not follow-up after the administrator had contacted them | It is called perseverance. You take responsibility for patients, and you continue calling. | Nurse/high-TR clinic |
| Usually, I nag the patients until they come in. There are patients who do not respond first so I need to nag them several times until they show up. | Nurse/high-TR clinic | |
| Step III: The PCP contacts patients who still had not followed-up | Most patients will respond positively to my request; if they do not follow through after the nurse has tried, they will think, well the doctor bothered calling so let’s try to follow his recommendations. | PCP/high-TR clinic |
| The doctor has more influence on the patient. When the doctor tells the patient that he needs him to do this and that and come back, well there is a lot of respect for the doctor, so he (patient) will not say no to the doctor. They respect me too, but with the doctor it is different. | Administrator/high-TR clinic | |
| I (doctor) prepare the list. I will ask the nurse to follow up. If she contacts the patient the same day, she gets back to me about when he can come in. | PCP/low-TR clinic | |
| Step IV: The social worker/family member reaches out to patients who still did not follow-up | The doctor will try to do what is needed. But sometimes you need to do more, so you ask the social workers to intervene. Especially when there are financial difficulties. | PCP/high-TR clinic |
| I had a patient who did not buy the medications, it turned out that he had financial problems, so we involved a social worker and now he receives the medications regularly. | Nurse/high-TR clinic | |
| If the patient is married, I always ask him to come with his wife. Usually, the wife is the one to handle things. | Nurse/high-TR clinic |
PCP = primary care physician; TR = temporal regularity.