title: Understanding issues associated with attending a young adult diabetes clinic: a case study.
abstract: OBJECTIVE
  To study the reasons for attendance behaviour from the patient viewpoint at a young adult diabetes outpatient clinic.
  
  
  METHODS
  Attendance 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.
  
  
  CONCLUSIONS
  Health 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.
authors.affiliation: NIHR King's Patient Safety and Service Quality Research Centre, King's College London, UK. rosamund.snow@kcl.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Snow
authors.forename: N
authors.initials: N
authors.lastname: Fulop
mesh_terms: D000293:Adolescent; D000328:Adult; D001071:Appointments and Schedules; D001294:Attitude to Health; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000628:therapy; D004739:England / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017010:Reminder Systems; D011795:Surveys and Questionnaires; D055815:Young Adult