Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti

Lily D. Yan; Dufens Pierre-Louis; Benito D. Isaac; Waking Jean-Baptiste; Serge Vertilus; Darius Fenelon; Lisa R. Hirschhorn; Patricia L. Hibberd; Emelia J. Benjamin; Gene Bukhman; Gene F. Kwan

doi:10.1186/s12889-020-09652-y

Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti

Lily D. Yan, Dufens Pierre-Louis, Benito D. Isaac, Waking Jean-Baptiste, Serge Vertilus, Darius Fenelon, Lisa R. Hirschhorn, Patricia L. Hibberd, Emelia J. Benjamin, Gene Bukhman, Gene F. Kwan^*

^*Corresponding author for this work

Medical Social Sciences

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

Background: Adherence to regular outpatient visits is vital to managing noncommunicable diseases (NCDs), a growing burden in low and middle-income countries. We characterized visit adherence among patients with NCDs in rural Haiti, hypothesizing higher poverty and distance from the clinic were associated with lower adherence. Methods: We analyzed electronic medical records from a cohort of adults in an NCD clinic in Mirebalais, Haiti (April 2013 to June 2016). Visit adherence was: 1) visit constancy (≥1 visit every 3 months), 2) no gaps in care (> 60 days between visits), 3) ≥1 visit in the last quarter, and 4) ≥6 visits per year. We incorporated an adapted measure of intensity of multidimensional poverty. We calculated distance from clinic as Euclidean distance or self-reported transit time. We used multivariable logistic regressions to assess the association between poverty, distance, and visit adherence. Results: We included 463 adult patients, mean age 57.8 years (SE 2.2), and 72.4% women. Over half of patients had at least one visit per quarter (58.1%), but a minority (19.6%) had no gaps between visits. Seventy percent of patients had a visit in the last quarter, and 73.9% made at least 6 visits per year. Only 9.9% of patients met all adherence criteria. In regression models, poverty was not associated with any adherence measures, and distance was only associated with visit in the last quarter (OR 0.87, 95% CI [0.78 to 0.98], p = 0.03) after adjusting for age, sex, and hardship financing. Conclusions: Visit adherence was low in this sample of adult patients presenting to a NCD Clinic in Haiti. Multidimensional poverty and distance from clinic were not associated with visit adherence measures among patients seen in the clinic, except for visit in the last quarter. Future research should focus on identifying and addressing barriers to visit adherence.

Original language	English (US)
Article number	1545
Journal	BMC public health
Volume	20
Issue number	1
DOIs	https://doi.org/10.1186/s12889-020-09652-y
State	Published - Dec 1 2020

Funding

The clinical care was delivered with joint support between the Haitian Ministry of Public and Population Health and Partners In Health/Zanmi Lasante, with funding by the Helmsley Charitable Trust. GFK was supported in part by the American Heart Association [grant number 17MCPRP33460298] and the National Heart, Lung, and Blood Institute [grant number K23HL140133]. LDY was supported by Preventive Medicine Residency Training grants from the Health Resources and Services Administration [grant numbers D33 HP 25766 and D33 HP 29243]. EJB was supported in part by NHLBI [grant numbers R01HL128914; 2R01 HL092577; 2U54HL120163, 1R01 HL141434 01A1, 1R01AG066010]; American Heart Association [grant number 18SFRN34110082]; and Robert Wood Johnson [grant 74624]. The funding organizations did not have any role in the design of the study and collection, analysis, and interpretation of data, or in writing the manuscript. Acknowledgements We thank the healthcare workers of HUM and Zanmi Lasante, and our patients in rural Haiti who encourage us to better serve the Haitian people. EJB reports grants from NHLBI, R01HL128914; 2R01 HL092577; 1R01 HL141434 01A1; 2U54HL120163; 1R01AG066010; and a grant from American Heart Association, 18SFRN34110082 during the conduct of the study. The remaining authors report no conflicts of interest related to the study.

Keywords

Global health
Haiti
Noncommunicable disease
Retention in care
Visit adherence

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12889-020-09652-y

Cite this

Yan, L. D., Pierre-Louis, D., Isaac, B. D., Jean-Baptiste, W., Vertilus, S., Fenelon, D., Hirschhorn, L. R., Hibberd, P. L., Benjamin, E. J., Bukhman, G., & Kwan, G. F. (2020). Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti. BMC public health, 20(1), Article 1545. https://doi.org/10.1186/s12889-020-09652-y

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title = "Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti",

abstract = "Background: Adherence to regular outpatient visits is vital to managing noncommunicable diseases (NCDs), a growing burden in low and middle-income countries. We characterized visit adherence among patients with NCDs in rural Haiti, hypothesizing higher poverty and distance from the clinic were associated with lower adherence. Methods: We analyzed electronic medical records from a cohort of adults in an NCD clinic in Mirebalais, Haiti (April 2013 to June 2016). Visit adherence was: 1) visit constancy (≥1 visit every 3 months), 2) no gaps in care (> 60 days between visits), 3) ≥1 visit in the last quarter, and 4) ≥6 visits per year. We incorporated an adapted measure of intensity of multidimensional poverty. We calculated distance from clinic as Euclidean distance or self-reported transit time. We used multivariable logistic regressions to assess the association between poverty, distance, and visit adherence. Results: We included 463 adult patients, mean age 57.8 years (SE 2.2), and 72.4% women. Over half of patients had at least one visit per quarter (58.1%), but a minority (19.6%) had no gaps between visits. Seventy percent of patients had a visit in the last quarter, and 73.9% made at least 6 visits per year. Only 9.9% of patients met all adherence criteria. In regression models, poverty was not associated with any adherence measures, and distance was only associated with visit in the last quarter (OR 0.87, 95% CI [0.78 to 0.98], p = 0.03) after adjusting for age, sex, and hardship financing. Conclusions: Visit adherence was low in this sample of adult patients presenting to a NCD Clinic in Haiti. Multidimensional poverty and distance from clinic were not associated with visit adherence measures among patients seen in the clinic, except for visit in the last quarter. Future research should focus on identifying and addressing barriers to visit adherence.",

keywords = "Global health, Haiti, Noncommunicable disease, Retention in care, Visit adherence",

author = "Yan, {Lily D.} and Dufens Pierre-Louis and Isaac, {Benito D.} and Waking Jean-Baptiste and Serge Vertilus and Darius Fenelon and Hirschhorn, {Lisa R.} and Hibberd, {Patricia L.} and Benjamin, {Emelia J.} and Gene Bukhman and Kwan, {Gene F.}",

note = "Funding Information: The clinical care was delivered with joint support between the Haitian Ministry of Public and Population Health and Partners In Health/Zanmi Lasante, with funding by the Helmsley Charitable Trust. GFK was supported in part by the American Heart Association [grant number 17MCPRP33460298] and the National Heart, Lung, and Blood Institute [grant number K23HL140133]. LDY was supported by Preventive Medicine Residency Training grants from the Health Resources and Services Administration [grant numbers D33 HP 25766 and D33 HP 29243]. EJB was supported in part by NHLBI [grant numbers R01HL128914; 2R01 HL092577; 2U54HL120163, 1R01 HL141434 01A1, 1R01AG066010]; American Heart Association [grant number 18SFRN34110082]; and Robert Wood Johnson [grant 74624]. The funding organizations did not have any role in the design of the study and collection, analysis, and interpretation of data, or in writing the manuscript. Acknowledgements Funding Information: We thank the healthcare workers of HUM and Zanmi Lasante, and our patients in rural Haiti who encourage us to better serve the Haitian people. Funding Information: EJB reports grants from NHLBI, R01HL128914; 2R01 HL092577; 1R01 HL141434 01A1; 2U54HL120163; 1R01AG066010; and a grant from American Heart Association, 18SFRN34110082 during the conduct of the study. The remaining authors report no conflicts of interest related to the study. Publisher Copyright: {\textcopyright} 2020, The Author(s).",

year = "2020",

month = dec,

day = "1",

doi = "10.1186/s12889-020-09652-y",

language = "English (US)",

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journal = "BMC public health",

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Yan, LD, Pierre-Louis, D, Isaac, BD, Jean-Baptiste, W, Vertilus, S, Fenelon, D, Hirschhorn, LR, Hibberd, PL, Benjamin, EJ, Bukhman, G & Kwan, GF 2020, 'Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti', BMC public health, vol. 20, no. 1, 1545. https://doi.org/10.1186/s12889-020-09652-y

TY - JOUR

T1 - Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti

AU - Yan, Lily D.

AU - Pierre-Louis, Dufens

AU - Isaac, Benito D.

AU - Jean-Baptiste, Waking

AU - Vertilus, Serge

AU - Fenelon, Darius

AU - Hirschhorn, Lisa R.

AU - Hibberd, Patricia L.

AU - Benjamin, Emelia J.

AU - Bukhman, Gene

AU - Kwan, Gene F.

N1 - Funding Information: The clinical care was delivered with joint support between the Haitian Ministry of Public and Population Health and Partners In Health/Zanmi Lasante, with funding by the Helmsley Charitable Trust. GFK was supported in part by the American Heart Association [grant number 17MCPRP33460298] and the National Heart, Lung, and Blood Institute [grant number K23HL140133]. LDY was supported by Preventive Medicine Residency Training grants from the Health Resources and Services Administration [grant numbers D33 HP 25766 and D33 HP 29243]. EJB was supported in part by NHLBI [grant numbers R01HL128914; 2R01 HL092577; 2U54HL120163, 1R01 HL141434 01A1, 1R01AG066010]; American Heart Association [grant number 18SFRN34110082]; and Robert Wood Johnson [grant 74624]. The funding organizations did not have any role in the design of the study and collection, analysis, and interpretation of data, or in writing the manuscript. Acknowledgements Funding Information: We thank the healthcare workers of HUM and Zanmi Lasante, and our patients in rural Haiti who encourage us to better serve the Haitian people. Funding Information: EJB reports grants from NHLBI, R01HL128914; 2R01 HL092577; 1R01 HL141434 01A1; 2U54HL120163; 1R01AG066010; and a grant from American Heart Association, 18SFRN34110082 during the conduct of the study. The remaining authors report no conflicts of interest related to the study. Publisher Copyright: © 2020, The Author(s).

PY - 2020/12/1

Y1 - 2020/12/1

N2 - Background: Adherence to regular outpatient visits is vital to managing noncommunicable diseases (NCDs), a growing burden in low and middle-income countries. We characterized visit adherence among patients with NCDs in rural Haiti, hypothesizing higher poverty and distance from the clinic were associated with lower adherence. Methods: We analyzed electronic medical records from a cohort of adults in an NCD clinic in Mirebalais, Haiti (April 2013 to June 2016). Visit adherence was: 1) visit constancy (≥1 visit every 3 months), 2) no gaps in care (> 60 days between visits), 3) ≥1 visit in the last quarter, and 4) ≥6 visits per year. We incorporated an adapted measure of intensity of multidimensional poverty. We calculated distance from clinic as Euclidean distance or self-reported transit time. We used multivariable logistic regressions to assess the association between poverty, distance, and visit adherence. Results: We included 463 adult patients, mean age 57.8 years (SE 2.2), and 72.4% women. Over half of patients had at least one visit per quarter (58.1%), but a minority (19.6%) had no gaps between visits. Seventy percent of patients had a visit in the last quarter, and 73.9% made at least 6 visits per year. Only 9.9% of patients met all adherence criteria. In regression models, poverty was not associated with any adherence measures, and distance was only associated with visit in the last quarter (OR 0.87, 95% CI [0.78 to 0.98], p = 0.03) after adjusting for age, sex, and hardship financing. Conclusions: Visit adherence was low in this sample of adult patients presenting to a NCD Clinic in Haiti. Multidimensional poverty and distance from clinic were not associated with visit adherence measures among patients seen in the clinic, except for visit in the last quarter. Future research should focus on identifying and addressing barriers to visit adherence.

AB - Background: Adherence to regular outpatient visits is vital to managing noncommunicable diseases (NCDs), a growing burden in low and middle-income countries. We characterized visit adherence among patients with NCDs in rural Haiti, hypothesizing higher poverty and distance from the clinic were associated with lower adherence. Methods: We analyzed electronic medical records from a cohort of adults in an NCD clinic in Mirebalais, Haiti (April 2013 to June 2016). Visit adherence was: 1) visit constancy (≥1 visit every 3 months), 2) no gaps in care (> 60 days between visits), 3) ≥1 visit in the last quarter, and 4) ≥6 visits per year. We incorporated an adapted measure of intensity of multidimensional poverty. We calculated distance from clinic as Euclidean distance or self-reported transit time. We used multivariable logistic regressions to assess the association between poverty, distance, and visit adherence. Results: We included 463 adult patients, mean age 57.8 years (SE 2.2), and 72.4% women. Over half of patients had at least one visit per quarter (58.1%), but a minority (19.6%) had no gaps between visits. Seventy percent of patients had a visit in the last quarter, and 73.9% made at least 6 visits per year. Only 9.9% of patients met all adherence criteria. In regression models, poverty was not associated with any adherence measures, and distance was only associated with visit in the last quarter (OR 0.87, 95% CI [0.78 to 0.98], p = 0.03) after adjusting for age, sex, and hardship financing. Conclusions: Visit adherence was low in this sample of adult patients presenting to a NCD Clinic in Haiti. Multidimensional poverty and distance from clinic were not associated with visit adherence measures among patients seen in the clinic, except for visit in the last quarter. Future research should focus on identifying and addressing barriers to visit adherence.

KW - Global health

KW - Haiti

KW - Noncommunicable disease

KW - Retention in care

KW - Visit adherence

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Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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