Understanding issues associated with attending a young adult diabetes clinic: a case study

R Snow,N Fulop

doi:10.1111/j.1464-5491.2011.03447.x

Abstract

Diabet. Med. 29, 257–259 (2012)AimsTo study the reasons for attendance behaviour from the patient viewpoint at a young adult diabetes outpatient clinic.MethodsAttendance rates for 231 clinic appointments over 19 months for 102 patients were calculated. Semi-structured interviews were conducted with a purposive sample of 17 of the 102. The interviews encouraged participants to describe routines, thoughts and feelings around clinic appointments. Observations were made of the clinic system. Themes arising from patients’ emotional and practical issues around attendance were generated from the data.Results‘Did not attend’ rates for the clinic over the study period were 15.7%. However, bureaucratic problems created many ‘missed’ appointments; most instances of ‘did not attend’ investigated were attributable to communication failures. Participants did not divide neatly into ‘attenders’/’non-attenders’; many had complex mixed attendance records. Most weighed the value of attendance against immediate obstacles such as incompatible work/clinic hours. Reminders were seen as important, particularly for this age group. Respondents identified fear of being judged for ‘poor control’ as a major factor in attendance decisions, suggesting that having a high HbA1c level may lead to non-attendance, rather than vice versa.ConclusionsHealth professionals’ supportive, non-judgemental attitude is important to patients considering clinic attendance. In this study, improved communication, reminders and flexible hours might reduce ‘did not attend’ rates.

Highlights

Improving attendance rates at outpatient clinics is often seen as important both in terms of avoiding the waste of medical resources and in terms of better overall health outcomes [1]
Three types of data were collected: (1) attendance records were analysed for 231 appointments for 102 individuals from November 2008 to May 2010; (2) semi-structured interviews were carried out with 17 patients registered at the young adult clinic; (3) the appointments and cancellation telephone line was monitored over a 3-week period
Patients’ attendance behaviour was complex, with many respondents reporting a change in attitude over time

Summary

Introduction

Improving attendance rates at outpatient clinics is often seen as important both in terms of avoiding the waste of medical resources and in terms of better overall health outcomes [1]. Much of the medical literature on non-attendance in diabetes points to significantly higher HbA1c results amongst ‘defaulters’ as an example of the benefits of clinic attendance [2]. Socio-demographic factors, such as gender and class, do not seem to be associated with missed appointments, some have found single parents and smokers to be more likely not to attend [7]; patients who feel that their recommended treatment is not effective are less likely to seek specialist care at clinic [8]. This study aimed to help redress that balance by exploring issues around attendance for this vulnerable age group, from the patient point of view

Methods

Results

Conclusion