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Setting up school-based diabetes clinics to engage adolescents who frequently ‘were not brought to clinic’ and improve self-management

Optimising attendance rates in outpatient’s clinics is important to ensure good clinical care and to avoid waste of scarce medical resources. We identified a cohort of teenagers that frequently were not brought (WNB) to the paediatric diabetes multidisciplinary clinics, compromising patient care and reducing compliance with National Padiatric Diabetes Audit (NPDA) standards. As these teenagers attend five local secondary schools, we initiated a quality improvement project to test the benefit of taking clinics into schools. From January 2017, after extensive engagement with stakeholders, quarterly clinic at school with a diabetic nurse and physician were offered to all teenagers with type 1 diabetes mellitus in these five schools. A semistructured interview was administered to identify their concerns about diabetes. HbA1c was checked, and glucose meters were downloaded. Outcome data were compared with previous 9 months. 34 teenagers were targeted (17 initially identified as frequent non-attenders and 17 controls at same schools). The hospital WNB rate was reduced in the intervention group by 50%, and patients not seen at least once in 3 months reduced from 9/17 to 1/17. Teenage patients expressed an increased positive experience. Relevant knowledge gaps and emotional difficulties were additionally identified and addressed. Lifestyle issues not previously known to team were also unveiled, for example, poor school attendance, bullying or high-risk behaviours. School clinics improved contact in this difficult to reach group. It shows promise as a vehicle to enhance engagement of young people in self-care, actively preparing them for transition.