Lost to follow-up: the problem of defaulters from diabetes clinics

Diabetes mellitus requires lifelong self-management with regular health professional support and supervision. Estimates of the prevalence of failed appointments at diabetes clinics vary but at less than 10% appear to be lower than for other non-chronic conditions. Yet the patients who do not attend have significantly more risk factors and complications than those who keep their appointments. In addition, failed appointments reduce clinic efficiency. To date, research on non-attendance for health care has largely focused on the characteristics of defaulters and evaluation of simple interventions aimed at directly altering their appointment-keeping behaviour, such as mailed reminders. However, like the broader issue of adherence, there are many factors that predispose to non-attendance ranging from patient health beliefs and attitudes of health professionals, the organization of the clinic and the financial costs of attendance, to the degree of patient participation within consultations. Consequently, there is a range of strategies from patient reminders and induction videos, logistical and administrative changes in the clinic, to training in consultation skills for health professionals that have the potential to decrease the numbers of patients lost to follow-up. Whether these will reduce morbidity efficiently should be the subject of further work.