Access to Outreach Athletic Trainers Improves Orthopedic Specialty Appointment Adherence

Background: Adolescent sports participation carries an inherent risk of musculoskeletal injury, with an estimated 2 million injuries occurring annually among high school athletes. Navigating the healthcare system to receive appropriate care can be challenging, potentially leading to delayed treatment and poorer outcomes. Athletic trainers (ATs) may play a crucial role in facilitating timely access to specialized care. The objective of this study was to assess the relationship between referral pathways (outreach athletic trainers (OATs), non-outreach athletic trainers (ATs), urgent care (UC), and emergency department (ED)) and appointment adherence while controlling for predisposing, enabling, and need factors. Methods: Using electronic medical record data of 14- to 17-year-old patients seen in a Midwest ambulatory orthopedic surgery department, adjusted logistic regressions were used to assess differences in appointment adherence between referral pathway groups. Results: Patients referred by OATs had significantly lower odds of no-show appointments compared to those referred through UC (aOR 2.90, 95% CI 1.05-8.02), ED (aOR 4.63, 95% CI 1.43-14.94), and non-affiliated ATs (aOR 3.09, 95% CI 1.20-7.95). Race, insurance type, and injury severity were also significant predictors of appointment adherence. Referral pathway was not significantly associated with appointment cancellation rates. Conclusions: Direct access to athletic trainers, especially those integrated within the healthcare system, significantly improves appointment adherence for adolescent patients seeking orthopedic care. Expanding athletic training services and strengthening care coordination efforts may improve access to timely and appropriate orthopedic care for adolescent athletes.