title: What happens to Palestine refugees with diabetes mellitus in a primary healthcare centre in Jordan who fail to attend a quarterly clinic appointment?
abstract: OBJECTIVE
  In a primary healthcare clinic in Jordan to determine: (i) treatment outcomes stratified by baseline characteristics of all patients with diabetes mellitus (DM) ever registered as of June 2012 and (ii) in those who failed to attend the clinic in the quarter (April-June 2012), the number who repeatedly did not attend in subsequent quarters up to 1 year later, again stratified by baseline characteristics.
  
  
  METHODS
  A retrospective cohort study with treatment outcome data collected and analysed using e-health and the cohort analysis approach in UNRWA Nuzha Primary Health Care Clinic for Palestine refugees, Amman, Jordan.
  
  
  RESULTS
  As of June 2012, there were 2974 patients with DM ever registered, of whom 2246 (76%) attended the clinic, 279 (9%) did not attend, 81 (3%) died, 67 (2%) were transferred out and 301 (10%) were lost to follow-up. A higher proportion of males and patients with undetermined or poor disease control failed to attend the clinic compared with those who attended the clinic. Of the 279 patients who did not attend the clinic in quarter 2, 2012, 144 (52%) were never seen for four consecutive quarters and were therefore defined as lost to follow-up. There were a few differences between patients who were lost to follow-up and those who re-attended at another visit that included some variation in age and fewer disease-related complications amongst those who were lost to follow-up.
  
  
  CONCLUSIONS
  This study endorses the value of e-health and cohort analysis for monitoring and managing patients with DM. Just over half of patients who fail to attend a scheduled quarterly appointment are declared lost to follow-up 1 year later, and systems need to be set up to identify and contact such patients so that those who are late for their appointments can be brought back to care and those who might have died or silently transferred out can be correctly recorded.
authors.affiliation: United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan.
authors.forename: Ali
authors.initials: A
authors.lastname: Khader
authors.affiliation: United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan.
authors.forename: Ghada
authors.initials: G
authors.lastname: Ballout
authors.affiliation: United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Shahin
authors.affiliation: United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan.
authors.forename: Majed
authors.initials: M
authors.lastname: Hababeh
authors.affiliation: United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan.
authors.forename: Loai
authors.initials: L
authors.lastname: Farajallah
authors.affiliation: United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan.
authors.forename: Wafaa
authors.initials: W
authors.lastname: Zeidan
authors.affiliation: Field Health Programme, UNRWA, Amman, Jordan.
authors.forename: Ishtaiwi
authors.initials: I
authors.lastname: Abu-Zayed
authors.affiliation: Tokyo University Medical School, Tokyo, Japan.
authors.forename: Arata
authors.initials: A
authors.lastname: Kochi
authors.affiliation: International Union against Tuberculosis and Lung Disease, Paris, France.|London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: Operational Research Unit, Medical Department, Medecins Sans Frontieres, Luxembourg, Luxembourg.
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: World Diabetes Foundation, Gentofte, Denmark.
authors.forename: Anil
authors.initials: A
authors.lastname: Kapur
authors.affiliation: United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan.
authors.forename: Irshad
authors.initials: I
authors.lastname: Shaikh
authors.affiliation: United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Seita
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001071:Appointments and Schedules; D018912:Arabs / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007597:Jordan / Q000453:epidemiology; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data; D011320:Primary Health Care; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Jordan; Palestine refugees; cohort reports; diabetes mellitus; failure to attend the clinic; lost to follow‐up