Burden of Travel is not Associated with Adherence to Follow-up Appointments – A Call for Centralization of Cleft Care in Germany

ObjectiveThe German system of care for patients with cleft lip and/or palate (CL/P) is fragmented. An argument against centralization is that the higher burden of travel for patients in remote and rural areas would reduce appointment adherence and subsequent care outcomes. Our objective was to test the association of travel burden and adherence and outline potential benefits of centralized cleft care.DesignFollow-up appointments June 2005 to August 2020 were retrospectively analyzed for patients with CL/P in a large German tertiary care center. Distance to care center and travel time by car/public transportation were calculated using Google Maps. Demographic characteristics included population density, degree of urbanization, and average disposable income per capita of the municipality of origin. Multiple regression models including flexible spatial function learning assessed associations with follow-up appointment adherence.ResultsPatients (n = 1140) had 9447 scheduled appointments with a 48.2% attendance rate. Distance to the clinic (M = 85.19 ± 75.12 km, range 0.45-536), travel time (M = 71.18 ± 48.5 min, range 2-330), population density (725.32 ± 807.82 inhabitants/km², range 14-4861), and lower average income (20,993.38 ± 1220.72 Euro, range 14,521-32,348.83) were not associated with appointment attendance. Patients from more rural areas were slightly more likely to attend check-ups (p = 0.027, 95% CI [0.016, 0.212]).ConclusionThe burden of travel to the clinic was not associated with attending follow-up appointments for patients with CL/P. These findings challenge a common assumption about attendance and warrant further multi-center studies to inform policy decisions for restructuring cleft care in Germany.