‘Did not attends’ in children 0–10: a scoping review

Abstract

Patients who do not attend (‘DNA’) health appointments have been identified as a service problem incurring significant costs to the NHS. In order to explore the causes, effects and costs of child DNAs, we carried out a scoping study to map the literature and identify gaps in the research. Given the breadth of issues underpinning DNAs, a scoping study, including research studies, audits, policy documents and conference abstracts, was the most useful way to map the field. To foster public and patient participation, we sought advice from parents participating in the National Children's Bureau's Family Research Advisory Group. From a pool of 1997 items, we found few UK studies with non‐attendance of 0–10 year olds as a primary focus, though many more incidentally reported DNA rates. Overall, four topics predominated: the conceptualization of DNAs; the correlates of non‐attendance; initiatives to reduce non‐attendance; and the relationship between non‐attendance and safeguarding. The Family Research Advisory Group identified broadly similar issues, but with a stronger emphasis on communication and practical matters. While there may be circumstances where failing to attend appointments makes little or no difference to a child (or even benefits them) it is likely that there are children whose health or well‐being are compromised as a result of failing to attend appointments. Both ‘over’ and ‘under'‐attendance can be a source of anxiety to health professionals. Areas where further work is needed include robust evaluation of the effectiveness, cost‐effectiveness and maintenance of measures to reduce DNAs and a better understanding of the relationship of safeguarding to non‐attendance.

Introducing consultant outpatient clinics to community settings to improve access to paediatrics: an observational impact study

“…The experience of this hospital further highlights that the choice of paediatricians to lead satellite clinics is of paramount importance; they need to embrace the ‘liberating’ ethos of working away from the hospital and adapt their clinical practice style accordingly. Our findings can also inform future research and innovation required to improve attendance as part of a wider challenge to address problems facing vulnerable families 10 23 24…”

The association between ethnicity and care pathway for children with emotional problems in routinely collected child and adolescent mental health services data

“…A number of theories could explain this: ethnic minority parents may be less likely to be registered with a primary care service, they may be less likely to seek professional treatment, there may be additional attitudinal barriers or concerns, or there may be cultural differences in symptom expression leading to misdiagnosis (Bhui & Bhugra, 2002;Bhui, et al, 2003;Bradby, et al, 2007;Morgan, et al, 2005). Another possible explanation might be that parents act as 'gatekeepers' to CAMHS along with GPs and their understanding of their children's illness and treatment options affects their likelihood of referral (Arai, Stapley, & Roberts, 2014).…”

“…Premature treatment termination and appointment non-attendance are major problems in CAMHS (Arai, Stapley, & Roberts, 2014), with some studies reporting 22% do not attend their first appointment (Minty & Anderson, 2004). In the studies cited above, there were reports of no significant associations between ethnicity and attendance of first appointment (Daryani et al, 2001) and reports that, although BAME children were no more likely to not attend their first appointment, they were more likely to terminate treatment prematurely (Skokauskas et al, 2010).…”

Moving on: Multiple Transitions of Unaccompanied Child Migrants Leaving Care in England and Sweden

“…We carried out a scoping review (Arai, Stapley, & Roberts, 2014;Arksey & O'Malley, 2005) to identify unaccompanied asylum seeking children's own health priorities, searching for qualitative first person 'voice' literature in both English and Swedish. The voices of disenfranchised people are frequently muted in research, 'translated' by professionals or researchers, or used to support a particular case rather than general illumination.…”