Characteristics of children who do not attend their hospital appointments, and GPs’ response: a mixed methods study in primary and secondary care

Background: Children who do not attend (DNA) their hospital outpatient appointments are a concern because this potentially compromises the child’s health and incurs financial cost. Little is known about children who DNA or the views of General Practitioners (GPs) to non-attendance.

Aim: Describe the characteristics of children who DNA hospital paediatric outpatient appointments and explore how GPs view and respond to DNAs.

Design and Setting: Data were extracted from patients’ hospital and GP records. Interviews were held with GPs.

Method: All new referrals to a children’s hospital in the South West of England between 1st September and 31st October 2012. STATA was used to analyse the data. Analysis focused on describing the characteristics of children who DNA and the process of care that followed. Interviews were analysed thematically.

Results: Children who DNA are more likely to be of black ethnicity (adjusted odds ratio [AOR] 2.11, 95% CI = 1.14 to 3.89, P = 0.017), from an area of greater deprivation (AOR 1.02, 95% CI = 1.00 to 1.02, P = 0.036), and with a child protection alert in their hospital notes (AOR 2.72, 95% CI = 1.26 to 5.88, P = 0.011). Non-attendance is communicated poorly to GPs, rarely coded in patient’s GP records and few GP practices have a formal policy regarding paediatric DNAs.

Conclusion: Non-attendance at hospital outpatient appointments may indicate a child’s welfare is at risk. Communication between primary and secondary care needs improving and guidelines developed to encourage GPs to monitor children who DNA.