Griffin S J
Primary Medical Care Group, Faculty of Health Medicine and Biological Sciences, University of Southampton, UK.
Diabet Med. 1998 Nov;15 Suppl 3:S14-24. doi: 10.1002/(sici)1096-9136(1998110)15:3+<s14::aid-dia725>3.3.co;2-9.
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.
糖尿病需要在健康专业人员的定期支持和监督下进行终身自我管理。糖尿病诊所预约失败率的估计各不相同，但低于10%的比例似乎低于其他非慢性疾病。然而，未就诊的患者比按时就诊的患者有更多的风险因素和并发症。此外，预约失败会降低诊所效率。迄今为止，关于医疗保健未就诊情况的研究主要集中在违约者的特征以及对旨在直接改变其预约行为的简单干预措施（如邮寄提醒）的评估上。然而，与更广泛的依从性问题一样，导致未就诊的因素有很多，从患者的健康信念、健康专业人员的态度、诊所的组织、就诊的经济成本，到患者在会诊中的参与程度。因此，有一系列策略，从患者提醒和介绍视频、诊所的后勤和行政变革，到健康专业人员的会诊技能培训，都有可能减少失访患者的数量。这些策略是否能有效降低发病率应是进一步研究的课题。
