title: Reasons for missed appointments with a hepatitis C outreach clinic: A qualitative study.
abstract: Non-attendance in drug service hepatitis C outreach clinics means clients miss the opportunity of being given lifestyle advice and referral to hospital for assessment and treatment. A similar problem is experienced in other services throughout the UK. A qualitative study was undertaken to investigate the problem.
  
  
  
  Clients with a history of not attending the outreach clinic were invited to participate during a routine drug clinic appointment. A contact details sheet with a preferred telephone number was completed by those agreeing to take part. Verbal consent was taken and a telephone interview took place. The participants were remunerated for taking part with a five pounds high street voucher. The 'framework method' was used to analyse the data with key themes identified.
  
  
  
  Twenty-eight telephone interviews were undertaken from April to June 2012. All the clients gave 'prima-facie' reasons for non-attendance including 'not a priority' and 'forgot'. However, the study indicates these are insufficient to explain the various experiences and influences. Underlying reasons that impacted upon attendance were identified. These reasons relate to (i) client characteristics e.g. 'priority' to score drugs and the 'cost of travel' and (ii) clinic service e.g. 'difficult journey' to the clinic and timing of the 'appointment'. The reasons operated within a complex context where other factors had an impact including addiction, welfare policy, stigma and the nature of hepatitis C itself.
  
  
  
  The study revealed that beneath apparently simple explanations for non-attendance, such as clients' chaotic lifestyle resulting in them forgetting or not being bothered to attend, there were far more complex and varied underlying reasons. This has important implications for drug policy including the need to better incorporate clients' perspectives. Policy that is based only on the simple, surface reasons is unlikely to be effective.
authors.affiliation: Department of Infection and Tropical Medicine, The Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, England, United Kingdom. Electronic address: ray.poll@sth.nhs.uk.
authors.forename: Ray
authors.initials: R
authors.lastname: Poll
authors.affiliation: Centre for Health and Social Care Research, Montgomery House, 32 Collegiate Crescent, Collegiate Campus, Sheffield S10 2BP, England, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Allmark
authors.affiliation: Faculty of Human and Medical Sciences, Room 5.319, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, England, United Kingdom.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Tod
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D005260:Female; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D036301:Qualitative Research; D055815:Young Adult
keywords: Drug use; Hepatitis C; Missed appointments; Outreach; Reasons; Telephone interviews