Human Outreach to Improve Adherence With Scheduled Pain Clinic Appointments

Language barriers may lead to poor attendance at pain clinic appointments, especially in underserved patients. Targeted interventions can help overcome barriers and significantly improve adherence, but have rarely been rigorously investigated in randomized clinical trials. Our objective is to investigate if (1) making a telephone call in the patient's preferred language increases adherance with scheduled appointment in an inner city academic pain clinic or at least reduces failure to attend without a prior cancellation call and (2) if this intervention is more effective in Spanish speakers.

After institutional review board approval and waiver of informed consent, we enroll all adult patients (18 years and up) with a scheduled first appointment at our outpatient Pain Center at Montefiore Medical Center located in the Bronx, New York from October 2014 through October 2015. Participants are randomized to receive a phone call in their preferred language before their appointment, or not. We recorded if participants attended as scheduled and/or called to cancel. We fit stratified and multivariate multinomial logistic regression models.

In a methodologically rigorous randomized design, we seek to demonstrate that a human phone call in the patient's primary language increases adherence with scheduled appointments in an ethnically diverse, poor population, typical for an inner city pain clinic. Our targeted intervention may provide considerable cost savings to the institution while bolstering the patient-doctor relationship and overcoming barriers to access much needed care.