S1526 After Visit Summary as an Intervention to Increase Patient Recall of Treatment Information in Telemedicine and In-Person Settings

Introduction: Estimates of patient adherence to treatment plan are low, and one contributor is poor recall of treatment plan and follow-up. The After Visit Summary (AVS) is a document that summarizes a patient’s visit content and their treatment plan instructions, yet it is not universally utilized across health systems. We aimed to evaluate the impact of the method of AVS delivery (hard copy vs patient portal) and visit modality (telemedicine vs in-person) on Inflammatory Bowel Disease (IBD) patients’ ability to recall their treatment plan. Methods: New IBD patients presenting to a tertiary center were randomized into 3 groups based on visit type and mode of AVS delivery (Figure 1). Clinical visits were standardized to include treatment recommendations and lifestyle modifications. The survey was delivered to each patient electronically 2 weeks following their visit. It included 8 questions assessing patient confidence in the recall of the visit discussion, a question regarding whether they needed to call back with questions, and a question asking what would have made it easier for them to understand their treatment plan. A mean “recall score” was calculated from each patient’s response to the first 8 questions. These scores were compared between groups for each question and overall. Results: Of 81 patients, 29 surveys were completed (35.8%). As shown in Table 1, no significant differences in recall scores were indicated. Only 3 respondents reported that they had to call back to ask a follow up question. The open-ended responses to question 10 (“what would have made it easier to understand your treatment plan?”) were centered around finances, insurance, and scheduling, as opposed to specific treatment information or discussion. Conclusion: Overall self-reported recall and confidence in managing one’s own care was high among patients regardless of visit type or mode of AVS delivery, underscoring the importance of clear and effective communication of care plans during patient visits. Limitations of this study include small sample size, patient inaccuracy in self-assessment of recall, and tertiary care referral bias as extended visit times for new patient encounters may impact generalizability of results. However, the AVS likely remains an effective tool to improve recall for IBD patients with complex clinical care plans. Additional investigations exploring patient adherence to IBD care plans based on recall of recommendations may be useful to measure the impact of AVS on longer term care.Figure 1.: Description of study groups by type of visit, AVS delivery, and number of responses. Table 1. - Survey responses by group. Questions 1-8 were prefaced with “Please rate your level of agreement with the following statements, where 1 = “Strongly Disagree” and 5 = “Strongly Agree” Group 1 Group 2 Group 3 Median Age 64 59 49 Gender 6 F, 3 M 3 F, 10 M 2 F, 5 M Diagnosis: Ulcerative Colitis (UC) 3 8 2 Diagnosis: Crohn's Disease (CD) 6 5 5 Number of Subjects Enrolled 28 22 31 Number of Responses 9 13 7 Overall Recall Score 3.97 4.37 4.11 Mean score Q1: "I understood the potential causes of my IBD" 4.38 4.31 4.43 Mean score Q2: "I am aware of the different treatment options that are available for my IBD" 4.33 4.38 4.43 Mean score Q3: "I understood the recommendations about diet and exercise for my IBD" 4.33 4.54 4.14 Mean score Q4: "I know how to manage my symptoms associated with my IBD" 4.13 4.15 4.00 Mean score Q5: "I know how to manage my IBD medications" 4.25 4.58 4.29 Mean score Q6: "My physician clearly explained my condition during my visit" 4.38 4.67 4.33 Mean score Q7: "I was given enough information during my visit" 4.38 4.75 4.29 Mean score Q8: "I have a better understanding of my treatment plan after my recent visit" 4.00 4.62 4.14 Need for call back (# respondents that indicated "yes") 2 0 1 Responses to Q10: "What would have made it easier for you to understand your treatment plan?" - "What suggestions of medications to be taking now to help with symptoms while waiting on insurance decisions which is a slow process" - "Directions on how to transfer my prescriptions to my new Mayo physician" - "Nothing more... Answered all my questions and was on time. I took to heart all 12 things he mentioned." - "Scheduled treatment plan before I left the office" - "Nothing, very thorough" - "Nothing, it was explained in great detail yet as simple as could be" - "We never discussed IBD" - "I was under the impression that by the end of this appointment or by the end of my pharmacy consult I would have a treatment plan figured out and that was not the case on either. Apparently I have to call my insurance company and do research myself and it would have been nice to know that ahead of time so I could have gotten things moving faster." - "A more detailed, in depth discussion of the possible financial ramifications for myself as a patient with regard to one of the proposed possible future treatment options for my IBD would have been helpful." - "Closer together appointments" - "Follow appointment quicker"