Original ArticleCare Utilization in a Pediatric Diabetes Clinic: Cancellations, Parental Attendance, and Mental Health Appointments
Section snippets
Methods
The Joslin Diabetes Center is located in Boston in an urban setting. Approximately 95% of the clinic's pediatric patients reside in Massachusetts or in neighboring New England states. These patients reflect the ethnic mixture of New England and represent all socioeconomic strata.
Our multidisciplinary pediatric diabetes team recommends visits according to American Diabetes Association (ADA) guidelines (roughly every 3-4 months) with a medical provider (MD, nurse practitioner [NP], or registered
Results
The 1771 individual patients (51% female) eligible for inclusion in this study had a total of 17 984 scheduled appointments during the 2-year observation period. The mean patient age at the time of the first visit during this 2-year period was 15 ± 5.2 years. The age distribution was 3% young children (0-5 years), 31% school-aged children (6-12 years), 32% adolescents (13-17 years), and 35% young adults (18-29 years). The mean duration of diabetes was 8.5 ± 5.1 years. At the first visit during
Discussion
Over a 2-year observation period, 15% of scheduled visits at an outpatient pediatric diabetes clinic yielded a cancellation or no-show, with an average of 1.6 ± 2.1 missed visits per patient. Sixty-one percent of patients missed at least 1 visit over the 2-year period, although the majority (60%) completed ≥6 visits over the 2-year period, consistent with ADA recommendations for visits every 3-4 months.31 Missed visit rates were higher for mental health providers and dieticians and lower for
References (45)
Type 1 diabetes
Lancet
(2006)- et al.
Impact of ambulatory, family-focused teamwork intervention on glycemic control in youth with type 1 diabetes
J Pediatr
(2003) - et al.
Parental involvement in diabetes management tasks: relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus
J Pediatr
(1997) - et al.
Impact of type 1 diabetes mellitus on the family is reduced with the medical home, care coordination, and family-centered care
J Pediatr
(2012) - et al.
Fathers of children and adolescents with diabetes: what do we know?
J Pediatr Nurs
(2008) - et al.
Psychological screening in adolescents with type 1 diabetes predicts outcomes one year later
Diabetes Res Clin Pract
(2011) The multidisciplinary team for children and adolescents with diabetes mellitus
J Pediatr Endocrinol Metab
(2002)- et al.
Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association
Diabetes Care
(2005) - et al.
Adherence to guidelines for youths with diabetes mellitus
Pediatrics
(2011) - et al.
An office-based intervention to maintain parent-adolescent teamwork in diabetes management: impact on parent involvement, family conflict, and subsequent glycemic control
Diabetes Care
(1999)
Paternal involvement in the management of pediatric chronic diseases: associations with adherence, quality of life, and health status
J Pediatr Psychol
Depression and anxiety in youth and young adults with type 1 diabetes
Diabetes
Eating disorders in adolescent females with and without type 1 diabetes: cross-sectional study
BMJ
Family conflict, adherence, and glycaemic control in youth with short duration type 1 diabetes
Diabet Med
Impaired insulin action in puberty: a contributing factor to poor glycemic control in adolescents with diabetes
N Engl J Med
Clinical and psychological course of diabetes from adolescence to young adulthood: a longitudinal cohort study
Diabetes Care
The impact of physiological, therapeutic and psychosocial variables on glycemic control in youth with type 1 diabetes mellitus
J Pediatr Endocrinol Metab
Attributions of adolescents with type 1 diabetes in social situations: relationship with expected adherence, diabetes stress, and metabolic control
Diabetes Care
Predictors of metabolic control among adolescents with diabetes: a 4-year longitudinal study
J Pediatr Psychol
Children with diabetes compared to peers: depressed? Distressed? A meta-analytic review
Ann Behav Med
Depressive symptoms and glycemic control in adolescents with type 1 diabetes: mediational role of blood glucose monitoring
Diabetes Care
Eating problems in adolescents with type 1 diabetes: a systematic review with meta-analysis
Diabet Med
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Funded by the National Institute of Diabetes and Digestive and Kidney Diseases (K23DK092335 and P30DK036836), the Eleanor Chesterman Beatson Fund, the Katherine Adler Astrove Youth Education Fund, and the Maria Griffin Drury Pediatric Fund. The authors declare no conflicts of interest.