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A Retrospective Audit into Ages and Reasons Why Individuals Fail to Attend (FTA) their Appointment at a Single Two Hour Structured Group Education

Programme, for People Newly Diagnosed with Type 2 Diabetes in North Wales

IntroductionAs a chronic disease, engaging patients with Type 2 diabetes at the early stage is very important (Ref 1).

A novel referral system was developed that allows rapid access, within a month, to a single two hour structured education session for people newly diagnosed with Type 2 diabetes (Ref 2, 3 & 4). Groups run at various locations on weekdays, in daytime. The FTA rate was 19% in 2011. It was hypothesised that patients under the age of 55 years were more likely to FTA due to work, family and other commitments. It was expected that a need for evening or weekend group sessions would be indicated.

Methods All new referrals and non attendance

data for newly diagnosed Type 2 diabetes patients was accessed from January to April 2012.

A questionnaire was sent to FTA patients, for further subjective information.

Patients were grouped in ten year brackets and comparisons were made using the Z-test.

Results From January to April 2012 three hundred and twenty six patients were referred to the Dietetic

Department for dietary advice for Type 2 diabetes. Criteria were applied to referrals as part of an agreed triage process and patients inappropriate for the group session were seen at an outpatient appointment.

245 patients attended (75% of total referrals) and 39 FTA (13.7% of total referrals) their chosen group session.

The FTA rate in the over 75 years group was lowest at 2.5%, despite being 15% of total referrals. As two cohorts, the younger age group (25-54 years) had an 18% FTA rate compared to 8% in the

older age group (55-75+ years). The FTA rate as a proportion of total referrals per age range was considered and using the z-test a

comparison drawn between the two cohorts, with significant results p = 0.026. However when data from the over 75 years age group is removed there is no significant statistical difference.

33% of the questionnaire sample was returned for analysis. Personal circumstances was cited as the most common reason for FTA.

ConclusionNo statistical difference is present between the two cohorts below the 75+ age range. Patients over the age of 75 years are least likely to FTA their chosen group session.

• The booking system adopted does not present a barrier to accessing the group.• Personal circumstances are the most common barrier to access. A need for evening/weekend sessions was not indicated.• 42% of respondents would like a future dietetic outpatient appointment.• It is recommended that a larger scale study is undertaken to explore age and related barriers to access with a greater focus on personal circumstances.• A system to reengage FTA patients is desirable.

Claire O’Kane 1, Paul Greene 1, Jim Turner 2 , Elaine Jennings 1

1. Department of Nutrition and Dietetics, Betsi Cadwalader University Health Board, Wrexham. 2. Clinical Audit Department, Betsi Cadwalader University Health Board, Wrexham.

References1. National Institute for Health and Clinical Excellence, CG 67, 2009.2. Jennings, E. A cost-effective addition to the structured education pathway for patients newly diagnosed with Type 2 diabetes. Diabetic Medicine, 2011, 28 (Supp.1), 124.3. Nasteva, G., Jennings, E,. Greene, P. , Mellor, D. & Harvey, J. A single session of structured education for newly diagnosed individuals with Type 2 diabetes enhances confidence in engaging group education and ability to self manage. Diabetic Medicine, 2012, 29 (Supp. 1), 112.4. Jennings, E., Greene, P., Nasteva G., Mellor, D., Cowley, P. & Harvey J. Evaluation of initial structured group education in newly diagnosed Type 2 diabetes. Diabetic Medicine, 2012, 29 ( Supp. 1), 113.

Patient questionnaire included the following:•Was confirmation of appointment received?

•Was the appointment confirmed by letter/telephone/both?

•Reason not attended? ( Six options available with space provided to include any other reason not specified.)

•Would you be interested in seeing a dietitian in the future? (GP contact advised for a future referral.)

•An additional box was provided for further patient comments.