School-based consultations boost diabetes clinic attendance in hard-to-reach teens
medwireNews: Meeting teenagers with diabetes at their schools to discuss concerns and reflect on self-management reduces the number who do not attend hospital clinics, say researchers.
The school-based individual consultations were run by a pediatrician and a diabetes nurse educator. They focused on allowing “the teenagers to express their concerns and reflect on their diabetes management rather than on a systematic assessment of glycaemic control,” say Yolanda Alins Sahun (Plymouth Hospitals NHS Trust, UK) and study co-authors.
The intervention focused on 34 teenagers with type 1 diabetes at five secondary schools in areas of high deprivation. The cohort included 17 teenagers who were repeated non-attenders at hospital clinics. These teenagers had either no contact over the preceding 3 months or had more than one non-attendance per quartile over the preceding 6 months. Yet 65% had glycated hemoglobin levels above 75 mmol/mol (9%) and had been offered 6-weekly appointments.
The quarterly school-based appointments alternated with regular hospital clinics for 6 months and “allowed us to actively involve these teenagers in self-management,” write the researchers in the Archives of Disease in Childhood.
They say the participants felt more able to discuss concerns about their diabetes at the school consultations, raising multiple issues the healthcare team had not previously been aware of, even in patients who attended hospital clinics regularly.
These included knowledge gaps, bullying or peer pressure, family difficulties, lack of privacy at hospital clinics, and parents taking control of hospital appointments.
The overall effect was to increase contact between the teenagers and their healthcare teams, with clinic contacts among the 17 who were frequent non-attenders increasing by 50% compared with during the 9 months before baseline. The number not seen for at least 3 months declined from nine to one.
“Our school clinics improved clinical contact and liberated scarce clinic slots, highlighting that extra hospital appointments may not be a suitable approach to all teenagers with poor glycaemic control,” say the researchers.
“The unintended benefits were facilitating engagement to improve self-management and improved healthcare for vulnerable adolescents.”
Furthermore, they say the experience “challenged us to look critically at our traditional model of care for teenagers,” including defining the role of parents, prioritizing the teenagers’ views, and improving the healthcare team’s counseling skills.
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