Understanding Access to Care: Factors Influencing Patient Attendance at Craniofacial Speech Evaluations.

Abstract

Evaluate predictors for attendance and adherence to speech evaluations and determine factors that influence longitudinal care for patients with cleft palate and craniofacial differences.

Retrospective, observational cohort study.

Tertiary children's hospital.

Eight hundred and eighty newborns receiving care between 2014 and 2022 were included in the study sample for longitudinal assessment of appointment adherence. Participants were included if they had a cleft-related diagnosis, were scheduled for an initial speech evaluation between 1 and 3 years old, were scheduled for follow-up speech evaluations between 3 and 6 years old, and had demographic, diagnostic, and clinical data in their charts.

Variables of interest included demographic data, diagnostic criteria, insurance data, distance to clinic, speech/resonance characteristics, hard/soft palate integrity, and surgical data. Chi-square analyses, independent sample t-tests, and descriptive statistics were conducted to identify characteristics of those who attended appointments and those who did not. Logistic regression analyses were conducted to examine factors predictive of appointment adherence over time.

A total of 66.9% of patients attended the initial speech evaluation. A total of 50.6% of participants adhered to follow-up appointments. Distance to clinic (P = .018), insurance type (P < .001), and cleft type (P < .001) influenced initial speech evaluation attendance. For follow-up appointment adherence, cleft type (P < .001) was the strongest predictor pre-pandemic, while severity of velopharyngeal function (P = .037) strongly predicted adherence during the pandemic.

Appointment adherence is multifactorial and driven by geographic, demographic, and clinical variables. Identifying barriers to care may improve appointment adherence for those with speech/resonance needs and prevent patients from being lost to follow-up.