Non‐attendance at diabetes outpatient appointments: a systematic review

Abstract

Background Non-attendance at diabetes outpatient appointments is a sizeable problem worldwide and has been associated with suboptimal health outcomes. We aimed to describe the characteristics, health outcomes and reasons given for non-attendance at doctor-or nurse-led diabetes appointments, and interventions to improve attendance. Methods PubMed, EMBASE, CINAHL and PsychInfo were searched from database inception to February 2019. Included articles were peer-reviewed, published in English, related to adults or young people with type 1 or type 2 diabetes, and addressed one of the above aspects of non-attendance. Studies were excluded if reporting on other types of diabetes or reviewing attendance at structured education, retinal screening, paediatric, antenatal, podiatry or dietetic clinics. Results Thirty-four studies of varied designs were identified (15 observational, 1 randomized control trial, 9 qualitative, 5 surveys, 4 service improvements). The definition of non-attendance varied. Younger adults, smokers and those with financial pressures were less likely to attend. Non-attendance was associated with higher HbA 1c ; other outcomes were varied but typically worse in non-attenders. Reasons for non-attendance in qualitative studies fell into three categories: balancing the costs and benefits of attendance, coping strategies, and the relationships between the person with diabetes and healthcare professionals. Interventions included appointment management strategies, service improvements, patient navigators and WebCam appointments. Conclusions Non-attendance is only partially explained by logistical issues. Qualitative studies suggest complex psychosocial factors are involved. Interventions have progressed from simple appointment reminders in an attempt to address some of the psycho-social determinants, but more work is needed to improve attendance.

Into the Storm: a Mixed Methods Evaluation of Reasons for Non-attendance of Appointments in the Free Clinic Setting

“…Patient navigators are a resource-intensive approach to increase attendance rates but have been successful at some clinics [8,11,19], with navigators being able to both identify reasons for non-attendance and improving patients' understanding of their need for appointments through personalized education. A major challenge to implementing this approach is the financial cost of a navigator to the clinic because they must be well educated on the services available at the clinic and in the community, as well as having a considerable time to work with patients to access these services.…”

The role of community pharmacists and their position in the delivery of diabetes care: an update for medical professionals

“…A healthcare appointment may not coincide with when an individual most needs help or support, and there are several reasons why an individual with diabetes may become ‘hardly reached’. It has been well described that ‘hardly reached’ individuals are at increased risk of diabetes-related complications 23…”

Facilitating participation in cardiovascular preventive initiatives among people with diabetes: a qualitative study

“…Recent systematic reviews found that non-participation in outpatient settings were related to appointment logistical issues, such as lack of exibility in the outpatient clinic and communication failures as well as socioeconomic and psychological factors (5,6). Additionally, Lee et al found that non-participation was associated with younger age, smoking and higher HbA 1c (6).…”

“…From an individual's perspective, a systematic review found reasons for non-participation in diabetes outpatient clinics could be categorised into I) poor relationship with the healthcare professionals (HPs), II) low perceived bene ts of participating and balancing the costs, and III) coping strategies like handing over management of diabetes to family members in particular (5). By contrast, people with T2D who previously participated in diabetes clinical trials expressed both altruism and self-interest as motives for participating (8).…”