Health care professionals' views of paediatric outpatient non-attendance: implications for general practice.
BACKGROUND
Non-attendance at paediatric hospital outpatient appointments poses potential risks to children's health and welfare. Prevention and management of missed appointments depends on the perceptions of clinicians and decision makers from both primary and secondary care, including general practitioners (GPs) who are integral to non-attendance follow-up.


OBJECTIVE
To examine the views of clinical, managerial and executive health care staff regarding occurrence and management of non-attendance at general paediatric outpatient clinics.


METHODS
A qualitative study using individual semi-structured interviews was carried out at three English Primary Care Trusts and a nearby children's hospital. Interviews were conducted with 37 staff, including GPs, hospital doctors, other health care professionals, managers, executives and commissioners. Participants were recruited through purposive and 'snowball' sampling methods. Data were analysed following a thematic framework approach.


RESULTS
GPs focused on situational difficulties for families, while hospital-based staff emphasized the influence of parents' beliefs on attendance. Managers, executives and commissioners presented a broad overview of both factors, but with less detailed views. All groups discussed sociodemographic factors, with non-attendance thought to be more likely in 'chaotic families'. Hospital interviewees emphasized child protection issues and the need for thorough follow-up of missed appointments. However, GPs were reluctant to interfere with parental responsibilities.


CONCLUSIONS
Parental motivation and practical and social barriers should be considered. Responsibilities regarding missed appointments are not clear across health care sectors, but GPs are uniquely placed to address non-attendance issues and are central to child safeguarding. Primary care policies and strategies could be introduced to reduce non-attendance and ensure children receive the care they require.
Health Psychology, Life and Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET.
Elaine
E
Cameron
Gemma
G
Heath
Sabi
S
Redwood
Sheila
S
Greenfield
Carole
C
Cummins
Deirdre
D
Kelly
Helen
H
Pattison
D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D058006:General Practice; D006297:Health Services Accessibility; D006776:Hospitals, Pediatric; D006801:Humans; D008505:Medical Staff, Hospital; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D008486:Physician Executives; D036301:Qualitative Research; D012959:Socioeconomic Factors; D014186:Transportation; D014195:Travel
Appointments and schedules; attitude of health personnel; child welfare; general practitioners; pediatrics; qualitative research.