Factors associated with clinic non-attendance in adults with Type 1 diabetes mellitus

Abstract

In order to examine the causes of non-attendance in a diabetic clinic, a 1-year retrospective casenote review of 259 diabetic patients with no evidence of major complications was undertaken. Frequency of clinic attendance, clinic non-attendance, and glycaemic control (HbA1c) were recorded. In a sub-sample of 82 patients, more detailed demographic data was obtained via questionnaire. During the previous year 39% of patients had failed to attend the clinic on at least one occasion and 10% were recurrent non-attenders. Non-attenders had a significantly higher mean HbA1c compared with those who did attend (8.1 +/- 2.2 vs 7.6 +/- 1.6%; p = 0.03). They were also significantly younger (mean age 27 + 7 vs 29 +/- 9 yrs; p = 0.02) and had a significantly shorter duration of diabetes (12 +/- 8 vs 15 +/- 10 yrs; p = 0.02). Attendance did not differ according to gender or age of onset of diabetes. Sub-sample analysis showed that smokers, those with children at home, and single parents were all more likely to default from their appointments. Non-attendance is a significant problem at our diabetic clinic, however, by addressing the reasons why patients fail to attend clinic we hope to develop strategies to encourage regular attendance. This may be translated into improved glycaemic control and ultimately reduce the risk of late diabetic complications.

Low attendance at structured education for people with newly diagnosed type 2 diabetes: General practice characteristics and individual patient factors predict uptake

“…In contrast, we did not find an association with age which has been identified in US studies [11,12,38]. In the US and Canada, younger people are more likely to attend diabetes education [12,19] which could be because they are more likely to be employed and therefore have medical insurance whereas in the UK there is no such incentive [38,39]. Those with better glycaemic control, non-smokers, and those with positive health beliefs about their diabetes treatment are more likely to attend suggests that current models of care are not targeting those who may need it the most and similar patterns have been observed in other health settings, such as diabetes clinics [39], cardiac rehabilitation [40], and mammography screening [41].…”

“…In the US and Canada, younger people are more likely to attend diabetes education [12,19] which could be because they are more likely to be employed and therefore have medical insurance whereas in the UK there is no such incentive [38,39]. Those with better glycaemic control, non-smokers, and those with positive health beliefs about their diabetes treatment are more likely to attend suggests that current models of care are not targeting those who may need it the most and similar patterns have been observed in other health settings, such as diabetes clinics [39], cardiac rehabilitation [40], and mammography screening [41]. On a positive note we did not find an association between ethnicity and attendance at structured education, found in one US study [12], although we did broadly group participants into ethnic groups and qualitative research has demonstrated that some West Africans might be opposed to group education for fear of stigmatisation [18].…”

Can valid and practical risk-prediction or casemix adjustment models, including adjustment for comorbidity, be generated from English hospital administrative data (Hospital Episode Statistics)? A national observational study

“…71 It has been reported that alcoholics, intravenous drug users and those who are pregnant have higher non-attendance rates, 75 as well as past and current smokers. 81,82 Patients who are single parents or have children living at home are more likely to be non-attenders. 81 Those with young, large families are also more likely to miss appointments, 76,83 as well as those with a poor family support system.…”

“…81,82 Patients who are single parents or have children living at home are more likely to be non-attenders. 81 Those with young, large families are also more likely to miss appointments, 76,83 as well as those with a poor family support system. 69 Area-level deprivation scores are often strong predictors of non-attendance.…”

Inequality of use of Cancer Genetics Services by members of breast, ovarian and colorectal cancer families in South East Scotland

“…In two studies [13,14] non attenders were more likely to be male. In two other studies [15,16] attendance was not related to gender.…”