Improving patient follow-up in developing regions

J Craniofac Surg. 2014 Sep;25(5):1640-4. doi: 10.1097/SCS.0000000000001147.


Background: Cleft surgery follow-up in developing regions is challenging. This study evaluated rates, costs, and satisfaction of 2 follow-up programs at the Guwahati Comprehensive Cleft Care Centre (GC4) in Assam, India.

Methods: For this study, 10,582 postoperative visits were analyzed from May 2011 to November 2013. A questionnaire was administered to subsets of follow-up patients at both locations. Costs were calculated.

Results: Eighty-five percent of patients had follow-up at GC4, and 15% were seen in the patients' local districts. One hundred ninety-five questionnaires were completed (122 at GC4, 73 in local districts). Patients with local follow-up had fewer accompanying family members (mean, 1.95 vs 0.99; P = 0.00), fewer days off work (mean, 1.84 vs 1.15; P = 0.19), less lost income (Indian rupees 367 vs 143, P = 0.00), and lower direct costs (mean Rs, 911 vs 299; P = 0.00). The financial burden of local follow-up was significantly lower (P = 0.003). No significant differences were seen for convenience, likelihood of attending follow-up, or satisfaction. Follow-ups increased after revising programs from a mean of 139 monthly visits (follow-up to surgery ratio of 0.722) to a mean of 363 visits (ratio of 1.57). The center's mean cost for local follow-up was Rs 303 per patient, whereas the estimated costs would have been Rs 1100 for follow-up at the center.

Conclusions: This study demonstrates potential improvements in costs and outcomes by changing the model of care. Despite significant follow-up challenges, much progress can be achieved through process changes and outreach follow-up programs. The results have important applications across the developing world.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism
  • Adolescent
  • Aftercare* / economics
  • Aftercare* / psychology
  • Appointments and Schedules
  • Child
  • Child, Preschool
  • Cleft Lip / surgery*
  • Cleft Palate / surgery*
  • Cohort Studies
  • Costs and Cost Analysis
  • Developing Countries*
  • Direct Service Costs
  • Family
  • Financing, Personal
  • Follow-Up Studies
  • Hospital-Patient Relations
  • Humans
  • Income
  • India
  • Infant
  • Patient Satisfaction
  • Surveys and Questionnaires
  • Travel