scholarly journals Borrowed Voices: Conversational Storytelling in Midwifery Healthcare Visits

1969 ◽  
Vol 25 (1) ◽  
Author(s):  
Pamela McKenzie ◽  
Philippa Spoel
Keyword(s):  
Clinic Visit ◽  
Structural Requirements ◽  
Conversational Storytelling ◽  
Mainstream Healthcare ◽  
Interactional Features ◽  
Clinic Visits

Midwifery in Ontario, Canada exists at the intersection of mainstream healthcare ideology and an alternative, woman-centred ideology of care. As a result, midwifery interaction is characterized by discursive hybridity. We trace this hybridity in the conversational stories co-narrated by midwives and clients during clinic visits. We show how conversational storytelling performs a complex shifting and blending of rhetorical forms and functions integral to the clinical interaction. Conversational stories conform to the structural requirements of the clinic visit and unfold in different ways and perform different functions at different times. Stories may be told, evaluated, and received as institutionally relevant for both clinical and social purposes. Clinical stories perform relational functions, and stories that appear to be fully social orient to the clinical agenda. Hybridity is accomplished through two forms of linguistic borrowing: the blending of professional-institutional and more casual-conversational modes, and interactional features such as shared narration and recontextualization.

scholarly journals Enhancing Patient-Provider Communication With the Electronic Self-Report Assessment for Cancer: A Randomized Trial

2011 ◽  
Vol 29 (8) ◽  
pp. 1029-1035 ◽  
Author(s):  
Donna L. Berry ◽  
Brent A. Blumenstein ◽  
Barbara Halpenny ◽  
Seth Wolpin ◽  
Jesse R. Fann ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Clinic Visit ◽  
Self Report ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Control Group ◽  
Cancer Symptoms ◽  
Patient Reported ◽  
Life Issues ◽  
Clinic Visits

Purpose Although patient-reported cancer symptoms and quality-of-life issues (SQLIs) have been promoted as essential to a comprehensive assessment, efficient and efficacious methods have not been widely tested in clinical settings. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment–Cancer (ESRA-C) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits. Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians. Patients and Methods This randomized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center. Patient-reported SQLIs were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit (n = 327); in the control group, no summary was provided (n = 333). SQLIs were scored for level of severity or distress. One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI. We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians. Results The likelihood of SQLIs being discussed differed by randomized group and depended on whether an SQLI was first reported as problematic (P = .032). Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful. Conclusion The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US randomized clinical trial.

The effect of a mobile health app on adherence to physical health treatment. (Preprint)

2021 ◽  
Author(s):  
Jay Greenstein ◽  
Robert Topp ◽  
Jena Etnoyer-Slaski ◽  
Michael Staelgraeve ◽  
John McNulty ◽  
...  
Keyword(s):  
Physical Health ◽  
Mobile Phone ◽  
Usual Care ◽  
Usual Care Group ◽  
Clinic Visit ◽  
Care Group ◽  
Health Treatment ◽  
Rehabilitation Clinic ◽  
The Impact ◽  
Clinic Visits

BACKGROUND Adhering to prescribed medical interventions predicts the efficacy of the treatment. In the physical health clinics, not adhering to prescribed therapy can take the form of not attending a scheduled clinic visit (no-show appointment) or prematurely terminating treatment against the advice of the provider (self-discharge). A variety of interventions, including mobile phone apps have been introduced with patients to increase their adherence with attending scheduled clinic visits. Limited research has examined the impact of a mobile phone app among patients attending a chiropractic and rehabilitation clinic visits. OBJECTIVE The purpose of this study was to compare adherence with prescribed physical health treatment among patients attending a chiropractic and rehabilitation clinic who did and did not choose to adopt a phone-based app to complement their treatment. METHODS The medical records of new patients who presented for care during 2019 and 2020 at five community-based chiropractic and rehabilitation clinics were reviewed for the number of kept and no-show appointments and if the patient was provider discharged or self-discharged. During this 24-month study 36.3% of the 4,126 patients seen in the targeted clinics had downloaded the Kanvas App to their mobile phone while the remaining patients chose not to download the app (Usual Care Group). The gamification component of the Kanvas app provided the patient with a point every time they attended their visits which could be redeemed for an incentive. RESULTS During both 2019 and 2020 respectively the Kanvas App Group (50%-38%) were provider discharged at a greater rate than the Usual-Care group (47-31%). The Kanvas App Group kept a similar number of appointments compared to the Usual-Care Group in 2019 (10.20 vs. 8.68) but kept significantly more appointments than the Usual-Care Group in 2020 (11.63 vs. 7.67). During 2019 both groups exhibited a similar number of no-show appointments (1.89 vs 1.96) but in 2020 the Kanvas App Group demonstrated more no-show appointments (2.89 vs 2.14) than the Usual Care. When collapsed across years and self discharged the Kanvas App group had a greater number of kept appointments (7.79) compared to the Usual Care group (4.58). When provider discharged both groups exhibited a similar number of kept appointments (15.25 vs 13.82). The Kanvas App group (1.38) and the Usual Care group (1.34) were similar in the number of no-show appointments when provider discharged and when self-discharged the Kanvas App Group had more no-show appointments (3.37) compared to the Usual Care Group (2.44). CONCLUSIONS When patients were provider discharged, they exhibited a similar number of kept appointments and no-show appointment. When subjects were self-discharged and received the Kanvas App they exhibited 3.2 more kept appointments and .94 more no-show appointments than self-discharged Usual Care group.

scholarly journals Disparity between Preoperative and Pre-Excisional Intraoperative Parathyroid Hormone in Parathyroid Surgery

2018 ◽  
Vol 22 (04) ◽  
pp. 382-386
Author(s):  
Maheer Masood ◽  
Trevor Hackman
Keyword(s):  
Parathyroid Hormone ◽  
Clinic Visit ◽  
Time Interval ◽  
Parathyroid Surgery ◽  
Academic Center ◽  
Significant Difference ◽  
Intraoperative Pth ◽  
Gland Function ◽  
Intraoperative Parathyroid Hormone ◽  
Clinic Visits

Introduction Intraoperative parathyroid hormone (ioPTH) testing is a widely accepted standard for assessing the parathyroid gland function. A decline of preoperative parathyroid hormone (PTH) levels by more than 50% is one accepted measure of parathyroid surgery adequacy. However, there may be a variation between preoperative PTH levels obtained at a clinic visit and pre-excisional ioPTH. Objective Our study explores the differences between preoperative PTH and pre-excisional ioPTH levels, and the potential impact this difference has on determining the adequacy of parathyroid surgery. Methods A retrospective study that consisted of 33 patients that had undergone parathyroid resection between September 2009 and March 2016 at a tertiary academic center was performed. Each subject's preoperative PTH levels were obtained from clinic visits and pre-excisional ioPTH levels were recorded along with the time interval between the measurements. Results There was a significant difference between the mean preoperative PTH and the pre-excisional ioPTH levels of 147 pg/mL (95% confidence interval [CI] 11.43 to 284.47; p = 0.0396). The exclusion of four outliers revealed a further significant difference with a mean of 35.09 pg/mL (95% CI 20.27 to 49.92; p < 0.0001). The average time interval between blood draws was 48 days + 32 days. A weak correlation between the change in PTH values and the time interval between preoperative and pre-excision blood draws was noted (r2 = 0.15). Conclusion Our study reveals a significant difference between the preoperative PTH levels obtained at clinic visits and the pre-excisional intraoperative PTH levels. We recommend routine pre-excisional intraoperative PTH levels, despite evidence of elevated preoperative PTH levels, in order to more accurately assess the adequacy of surgical resection.

scholarly journals The Heart Failure Readmission Intervention by Variable Early Follow-up (THRIVE) Study

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Keane K. Lee ◽  
Rachel C. Thomas ◽  
Thida C. Tan ◽  
Thomas K. Leong ◽  
Anthony Steimle ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care Physicians ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Clinic Visit ◽  
Heart Failure Hospitalization ◽  
Healthcare Delivery System ◽  
Unique Identifier ◽  
Clinic Visits

Background: In-person clinic follow-up within 7 days after discharge from a heart failure hospitalization is associated with lower 30-day readmission. However, health systems and patients may find it difficult to complete an early postdischarge clinic visit, especially during the current pandemic. We evaluated the effect on 30-day readmission and death of follow-up within 7 days postdischarge guided by an initial structured nonphysician telephone visit compared with follow-up guided by an initial clinic visit with a physician. Methods and Results: We conducted a pragmatic randomized trial in a large integrated healthcare delivery system. Adults being discharged home after hospitalization for heart failure were randomly assigned to either an initial telephone visit with a nurse or pharmacist to guide follow-up or an initial in-person clinic appointment with primary care physicians providing usual care within the first 7 days postdischarge. Telephone appointments included a structured protocol enabling medication titration, laboratory ordering, and booking urgent clinic visits as needed under physician supervision. Outcomes included 30-day readmissions and death and frequency and type of completed follow-up within 7 days of discharge. Among 2091 participants (mean age 78 years, 44% women), there were no significant differences in 30-day heart failure readmission (8.6% telephone, 10.6% clinic, P =0.11), all-cause readmission (18.8% telephone, 20.6% clinic, P =0.30), and all-cause death (4.0% telephone, 4.6% clinic, P =0.49). Completed 7-day follow-up was higher in 1027 patients randomized to telephone follow-up (92%) compared with 1064 patients assigned to physician clinic follow-up (79%, P <0.001). Overall frequency of clinic visits during the first 7 days postdischarge was lower in participants assigned to nonphysician telephone guided follow-up (48%) compared with physician clinic-guided follow-up (77%, P <0.001). Conclusions: Early, structured telephone follow-up after hospitalization for heart failure can increase 7-day follow-up and reduce in-person visits with comparable 30-day clinical outcomes within an integrated care delivery framework. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03524534.

A randomized trial evaluating the integration of online questionnaires into follow-up (FU) care for early-stage breast cancer (ESBC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9107-9107
Author(s):  
Alyse Wheelock ◽  
Meredith Bock ◽  
Eva Mihalis ◽  
Nancy Shepard ◽  
Dan H. Moore ◽  
...  
Keyword(s):  
Early Stage ◽  
Clinic Visit ◽  
Physician Visits ◽  
Medical Tests ◽  
Large Numbers ◽  
Significant Difference ◽  
Kolmogorov Smirnov ◽  
On Line ◽  
Oncology Providers ◽  
Clinic Visits

9107 Background: Large numbers of cancer survivors have led to the need for FU care addressing lasting effects of BC and its treatment. We conducted a trial evaluating formats of FU care to determine if integration of remote electronic questionnaire FU provides for timely symptom management and more efficient care than routine clinic visits alone. Methods: Patients (pts) with ESBC were randomized to either usual care (UC, frequency of visits determined by oncology providers) with completion of an optional online health and symptom questionnaire (Q) before each clinic visit, or to SIS.NET FU care, in which pts were scheduled for up to 3 routine oncology related clinic visits over 18 mos and completed the online Q every 3 mos. Qs were reviewed by a survivorship nurse practitioner (NP) with pt phone contact for symptoms requiring urgent attention. We recorded the time between electronic symptom reporting and FU for pts in the SIS.NET arm. Data included the number of oncology related clinic visits, total number of physician visits, and number of medical tests including labs and imaging studies ordered. Kolmogorov-Smirnov tests for equal distributions were used to determine if there were any significant differences between SIS.NET and UC. Results: 100 pts were enrolled, 75 completed the 18 month study and 25 pts remain in FU. For the 75 pts, 85% received chemotherapy and 77% received hormone therapy. Pts in the SIS.NET arm completed an average of 3.8 out of 7.2 emailed surveys (52.6%), and pts in the UC arm completed an average of 2.2 out of 3.4 (69.1%) routine pre-clinic surveys. For pts in the SIS.NET arm, 75% of reported symptoms were reviewed by a NP in < 3 days. There was no significant difference between SIS.NET and UC FU for oncology related clinic appointments, total number of physician visits, or number of medical tests performed. Conclusions: Use of on-line health and symptom surveys with remote NP review provided timely symptom FU but did not reduce clinic visits or medical testing in pts with ESBC. Further analyses of these data as well as additional studies are necessary to understand the barriers to integration of web-based tools to achieve more efficient FU care for BC survivors.

Home ePRO compliance in prostate cancer clinical studies.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2063-2063
Author(s):  
Sarah Tressel Gary ◽  
Nadeeka Dias ◽  
Elisa Conrad ◽  
Kenneth G Faulkner
Keyword(s):  
Prostate Cancer ◽  
Clinical Studies ◽  
Daily Diary ◽  
Clinic Visit ◽  
Lower Number ◽  
Quality Data ◽  
Assessment Period ◽  
Patient Reported ◽  
Clinic Visits ◽  
At Home

2063 Background: Patient-reported outcomes (PRO) and electronic PRO (ePRO) play an important role in the development and approval of cancer products. Regulatory agencies are encouraging the inclusion of PRO-based endpoints that are indicative of clinical benefit in terms of patient symptoms and overall quality of life (QOL). Compliance with completion of ePRO assessments is an important component for obtaining accurate and high-quality data when conducting clinical trials. Traditionally, ePRO data in oncology trials has been collected mainly at clinic visits due to concerns over poor compliance at home. However, since symptoms and QOL can vary widely through a treatment course, it is often necessary to collect ePRO data more frequently in between clinic visits. It has been hypothesized that home completion, length of time in a study, and number of assessments may affect compliance. Methods: To address this hypothesis, ePRO compliance data was analyzed from two clinical studies in prostate cancer. Both studies used a handheld smartphone that contained an application to collect ePRO data. At the randomization visit, subjects completed ePRO assessments in clinic (2-3 questionnaires). Subsequently, all assessments were completed at home, including a daily diary and 1-4 questionnaires completed every 4-8 weeks for up to 14 months. Compliance was calculated as the number of assessments received divided by the number of assessments expected in a given assessment period. To evaluate assessment burden, each assessment period was categorized as requiring a lower number (daily diary and 1 questionnaire) or higher number (daily diary and 2-4 questionnaires) of assessments. Results: A total of 1,040 patients were included in the analysis. Overall compliance at the single clinic visit was 100%, which was expected since it was a required randomization visit. Overall compliance at home over 14 months was 80%. Compliance ranged from 78% to 89% over the duration of the studies, with no effect of time in the study on compliance. Compliance remained high even as patient numbers declined. Compliance when patients were required to complete a lower number of assessments (80%) was similar to compliance when patients were required to complete a higher number of assessments (79%). Compliance by region varied from 72% (Middle East) to 87% (Asia and Eastern Europe). Conclusions: The collection of ePRO at home provided high compliance that did not vary with length of time in the study or due to assessment burden. At home ePRO assessments provide an effective and feasible approach for recording symptoms and QOL in prostate cancer patients.

scholarly journals Randomized, placebo controlled, double blinded pilot superiority phase 2 trial to evaluate the effect of curcumin in moderate to severe asthmatics

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michele Quan ◽  
Abdullah Alismail ◽  
Noha Daher ◽  
Derrick Cleland ◽  
Sonia Chavan ◽  
...  
Keyword(s):  
Asthma Control ◽  
Clinic Visit ◽  
Phone Call ◽  
Blood Eosinophil ◽  
Therapeutic Effects ◽  
Phase 2 ◽  
Asthma Control Test ◽  
Phase 2 Trial ◽  
Double Blinded ◽  
Clinic Visits

Abstract Background Curcumin, a derivative of the spice turmeric, has been adopted by Eastern medicine for centuries as an adjunct to treat several medical conditions (e.g., anorexia and arthritis) because of its well-established anti-inflammatory properties. Studies have shown that the use of curcumin in mice models has led to reduction in several inflammatory markers as well as key inflammatory pathway enzymes. As a result, studies in Western medicine have developed to determine if this recognized benefit can be utilized for patients with inflammatory lung diseases, such as asthma. This study will seek to better understand if curcumin can be used as an adjunctive therapy for improving asthma control of patients with moderate to severe asthma; a finding we hope will allow for a more affordable treatment. Methods This study will utilize a randomized, placebo controlled, double blinded pilot superiority phase 2 trial at an outpatient pulmonary clinic in Southern California, USA. Subjects will be receiving Curcumin 1500 mg or matching placebo by mouth twice daily for the study period of 12 weeks. Subjects will be randomized to either a placebo or intervention Curcumin. Subjects will have 6 clinic visits: screening visit, a baseline visit, monthly clinic visits (weeks 4, 8, and 12), at weeks 4, 8, and a follow-up clinic visit or phone-call (week 16). Changes in asthma control test scores, number of days missed from school/work, FEV1 (% predicted), FEV1/FVC ratio, FVC (% predicted), blood eosinophil count, blood total IgE, and FeNO levels will be compared by group over time. Discussion The therapeutic effects of curcumin have been studied on a limited basis in asthmatics and has shown mixed results thus far. Our study hopes to further establish the benefits of curcumin, however, there are potential issues that may arise from our study design that we will address within this paper. Moreover, the onset of the COVID-19 pandemic has resulted in safety concerns that have delayed initiation of our study. This study will contribute to existing literature on curcumin’s role in reducing lung inflammation as it presents in asthmatics as well as patients suffering from COVID-19. Trial registration This study protocol has been approved by the Institutional Review Board at Loma Linda University Health, (NCT04353310). IND# 145101 Registered April 20th, 2020. https://clinicaltrials.gov/ct2/show/NCT04353310.

scholarly journals High Acceptance of HIV Self-testing Among PrEP Recipients before COVID-19 Era: A Cross-sectional Analysis from PrEP Demonstration Project of MSM in China

2020 ◽  
Author(s):  
Jing Zhang ◽  
Wei-ming Tang ◽  
Xia Jin ◽  
Hong-yi Wang ◽  
Zhen-xing Chu ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Clinic Visit ◽  
Cross Sectional ◽  
On Demand ◽  
Testing Frequency ◽  
Self Testing ◽  
Exposure Prophylaxis ◽  
Sectional Analysis ◽  
The Impact ◽  
Clinic Visits

Abstract Background: Many Pre-exposure prophylaxis (PrEP) users have difficulty attending the quarterly facility-based HIV testing, which leads to the potential risk of drug resistance in the context of breakthrough infection with low drug compliance. We explored the acceptance of HIV self-testing (HIVST) service among PrEP recipients. Methods: MSM were recruited for the PrEP demonstration in four major cities in China from December 2018 to September 2019, provided with regimens of both daily and on-demand PrEP. Facility-based HIV testing was provided quarterly at clinic visits. Previous HIV testing history and acceptance of free HIVST kits to use between each quarterly clinic visit was collected. Correlates of levels of acceptance were analysed using multivariable ordinal logistic regression. Results: We recruited 1,222 MSM. among which 48.5% preferred daily PrEP and 51.5% preferred on-demand PrEP. There was 26.8% (321/1222) had never been to any facility-based HIV testing previously, and the self-reported major reason was that they had already routinely used HIVST. A quarter of the participants (74.5%, 910/1222) had used HIVST previously. There were 1184 MSM (96.9%) accepted to use HIVST between each quarterly clinic visits during PrEP usage, composing 947 ( 77.5%) very willing to, 237（19.4%）willing to, 29 (2.4%) unwilling to, and 9 (0.7%) very unwilling to. Participants preferred daily PrEP (vs. on-demand PrEP, aOR=1.8, 95% CI:1.3-2.4) and had less than 2 times of facility-based HIV testing in the past year (vs. ³2, aOR=1.4,95% CI:1.1-1.9) were more likely to have higher level of acceptance of HIVST.Conclusions: MSM had high acceptance of HIVST, especially among those preferred daily PrEP and with less facility-based HIV testing in the previous year. Offering HIVST services PrEP recipients is feasible and necessary. Above result is of great significance for promoting HIVST among PrEP users during COVID-19, improving awareness of their HIV infection status and ensuring compliance with medication. Future study should exam the impact of HIVST on HIV testing frequency among PrEP users.Trial registration: ChiCTR1800020374 on 27th Dec 2018. http://www.chictr.org.cn/searchproj.aspx

scholarly journals A-18 Utility of the Child SCAT-5: Performance Differences Across Assessments in Pediatric Concussion

2020 ◽  
Vol 35 (5) ◽  
pp. 614-614
Author(s):  
V Fazio-Sumrok ◽  
N Blaney ◽  
A Kissinger-Knox ◽  
S Eagle ◽  
N Kegel ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Assessment Tool ◽  
Memory Performance ◽  
Clinic Visit ◽  
Symptom Improvement ◽  
Balance Performance ◽  
Immediate Memory ◽  
Clinical Encounters ◽  
Pediatric Concussion ◽  
Clinic Visits

Abstract Objective In 2017, the Sport Concussion Assessment Tool-5 Child (Child SCAT-5) was introduced as a tool for clinicians to assess cognitive function and symptoms in children following a concussion (Davis, 2017; Echmendia, 2017); however, there are limited data supporting its use. The purpose of this study was to assess performance on the Child SCAT-5 among concussed pediatric patients (i.e., 5–9 years) across two clinic visits. Method Participants included 95 children (42.15% female) aged 5–9 years (7.42 +/− 1.12) who were diagnosed with a concussion within 30 days of injury (8.75 +/− 5.65 days). Patients underwent clinical interview and Child SCAT-5. Paired t-tests were used to compare measures on symptomatology, neurocognitive function, and balance performance between their first two clinical encounters (18.07 +/− 16.05 days). Results Analyses revealed significant improvements for immediate memory (p &lt; 0.001) and delayed recall (p = 0.035), as well as improvements in symptom count (p &lt; 0.001), symptom severity (p &lt; 0.001), and back-to-normal rating (p = 0.004). Headaches (85.6%), feeling tired a lot (65.9%), getting tired easily (59.3%), difficulty concentrating (57.1%), and being distracted (54.9%) were the most commonly reported symptoms at patients’ initial clinic visit. Conclusions The findings from this study indicate that the Child SCAT-5 is useful for identifying common symptoms in pediatric patients tracking symptom improvement across clinic visits. The measure was also useful in identifying improvements in neurocognitive functioning in this population, particularly memory performance. Further research should focus on how the Child SCAT-5 and other pediatric-specific measures can assess and track improvement in clinical outcomes for this at-risk population.

scholarly journals Routine HIV clinic visit adherence in the African Cohort Study

2022 ◽  
Vol 19 (1) ◽  
Author(s):  
Nicole Dear ◽  
Allahna Esber ◽  
Michael Iroezindu ◽  
Emmanuel Bahemana ◽  
Hannah Kibuuka ◽  
...  
Keyword(s):  
Cohort Study ◽  
Virologic Failure ◽  
Clinical Care ◽  
Clinic Visit ◽  
People Living With Hiv ◽  
The Past ◽  
Visit Adherence ◽  
Missed Visits ◽  
History Of ◽  
Clinic Visits

Abstract Background Retention in clinical care is important for people living with HIV (PLWH). Evidence suggests that missed clinic visits are associated with interruptions in antiretroviral therapy (ART), lower CD4 counts, virologic failure, and overlooked coinfections. We identified factors associated with missed routine clinic visits in the African Cohort Study (AFRICOS). Methods In 2013, AFRICOS began enrolling people with and without HIV in Uganda, Kenya, Tanzania, and Nigeria. At enrollment and every 6 months thereafter, sociodemographic questionnaires are administered and clinical outcomes assessed. Missed clinic visits were measured as the self-reported number of clinic visits missed in the past 6 months and dichotomized into none or one or more visits missed. Logistic regression with generalized estimating equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between risk factors and missed visits. Results Between January 2013 and March 2020, 2937 PLWH were enrolled, of whom 2807 (95.6%) had initiated ART and 2771 had complete data available for analyses. Compared to PLWH 50+, missed clinic visits were more common among those 18–29 years (aOR 2.33, 95% CI 1.65–3.29), 30–39 years (aOR 1.59, 95% CI 1.19–2.13), and 40–49 years (aOR 1.42, 95% CI 1.07–1.89). As compared to PLWH on ART for < 2 years, those on ART for 4+ years were less likely to have missed clinic visits (aOR 0.72, 95% CI 0.55–0.95). Missed clinic visits were associated with alcohol use (aOR 1.34, 95% CI 1.05–1.70), a history of incarceration (aOR 1.42, 95% CI 1.07–1.88), depression (aOR 1.47, 95% CI 1.13–1.91), and viral non-suppression (aOR 2.50, 95% CI 2.00–3.12). As compared to PLWH who did not miss any ART in the past month, missed clinic visits were more common among those who missed 1–2 days (aOR 2.09, 95% CI 1.65–2.64) and 3+ days of ART (aOR 7.06, 95% CI 5.43–9.19). Conclusions Inconsistent clinic attendance is associated with worsened HIV-related outcomes. Strategies to improve visit adherence are especially needed for young PLWH and those with depression.

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