title: Appointment keeping for medical review among patients with selected chronic diseases in an urban area of Uganda.
abstract: BACKGROUND
  Proper management of chronic diseases is important for prevention of disease complications and yet some patients miss appointments for medical review thereby missing the opportunity for proper monitoring of their disease conditions. There is limited information on missed appointments among chronic disease patients in resource limited settings. This study aimed to determine the prevalence of missed appointments for medical review and associated factors among chronic disease patients in an urban area of Uganda.
  
  
  METHODS
  Patients or caregivers of children with chronic diseases were identified as they bought medicines from a community pharmacy. They were visited at home to access their medical documents and those whose chronic disease status was ascertained were enrolled. The data was collected using: questionnaires, review of medical documents, and in-depth interviews with chronic disease patients.
  
  
  RESULTS
  The prevalence of missed appointments was 42% (95%CI = 35-49%). The factors associated with missed appointments were: monthly income ≤30US Dollars (OR = 2.56, CI = 1.25-5.26), affording less than half of prescribed drugs (OR = 3.92, CI = 1.64-9.40), not experiencing adverse events (OR = 2.66, CI = 1.26-5.61), not sure if treatment helps (OR = 2.84, CI = 1.047.77), not having a medicines administration schedule (OR = 6.77, CI = 2.11-21.68), and increasing number of drugs (OR = 0.72, CI = 0.53-0.98).
  
  
  CONCLUSIONS
  Patients missed appointments mainly due to: financial and health system barriers, conflicting commitments with appointments, and perceptions of the disease condition. Patients should be supported with accessible and affordable health services.
authors.affiliation: School of Pharmacy, Queens University Belfast, BT9 7BL, Belfast, Northern Ireland ; Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda ; Department of Pharmacy, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
authors.forename: Joan Nakayaga
authors.initials: JN
authors.lastname: Kalyango
authors.affiliation: School of Pharmacy, Queens University Belfast, BT9 7BL, Belfast, Northern Ireland.
authors.forename: Maurice
authors.initials: M
authors.lastname: Hall
authors.affiliation: Clinical Epidemiology Unit, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda ; Department of Paediatrics and Child health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
authors.forename: Charles
authors.initials: C
authors.lastname: Karamagi
mesh_terms: D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D017028:Caregivers / Q000706:statistics & numerical data; D002908:Chronic Disease; D003157:Community Pharmacy Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014454:Uganda; D014505:Urban Population
keywords: Chronic disease; medical review appointments; missed appointments
references.citation: Saudi Med J. 2002 Apr;23(4):388-92
references.pmid: 11953761
references.citation: Med Care. 2004 Feb;42(2):110-5
references.pmid: 14734947
references.citation: J R Soc Med. 2002 Jun;95(6):284-6
references.pmid: 12042374
references.citation: Swiss Med Wkly. 2007 Dec 1;137(47-48):677-81
references.pmid: 18058276
references.citation: Patient Educ Couns. 2005 Jun;57(3):300-7
references.pmid: 15893212
references.citation: Bull World Health Organ. 2010 Dec 1;88(12):943-8
references.pmid: 21124720
references.citation: Evid Based Med. 2013 Jun;18(3):112-3
references.pmid: 22930341
references.citation: Braz J Infect Dis. 2012 Jul-Aug;16(4):315-20
references.pmid: 22846117
references.citation: BMJ. 2005 Mar 19;330(7492):644-8
references.pmid: 15774996
references.citation: Bull World Health Organ. 2007 Apr;85(4):279-88
references.pmid: 17546309
references.citation: J Gen Intern Med. 2008 Oct;23(10):1685-7
references.pmid: 18661189
references.citation: Ann Fam Med. 2004 Nov-Dec;2(6):541-5
references.pmid: 15576538
references.citation: Nurse Educ Today. 2004 Feb;24(2):105-12
references.pmid: 14769454
references.citation: BMC Health Serv Res. 2012;12:323
references.pmid: 22988920
references.citation: JAMA. 1992 Apr 1;267(13):1813-7
references.pmid: 1532036