Non-attendance at drug service Hepatitis C outreach clinics: clients and staff experiences.

Non-attendance in the drug service hepatitis C outreach clinic means clients miss essential components of care: being offered lifestyle advice such as limiting their alcohol intake (to prevent further progression of liver disease);a discussion about ways to avoid transmission to others; and referral for hospital treatment, which can be curative.

In the absence of much empirical evidence many suggestions have been given for missed appointments by hepatitis C patients. For example, they forget, lead ‘chaotic lifestyles’, the infection is ‘not a priority’ to them and they are ‘hard-to-reach’.

This study was undertaken to investigate beneath these ‘surface’ reasons for non-attendance. Thus, a realist approach was taken. The study comprised three phases of theory development and testing that incorporated qualitative telephone interviews with clients followed by a national survey of staff.

All 28 clients who participated gave ‘surface’ or ‘prima-facie’ reasons for non-attendance. However, the study revealed hidden underlying factors (mechanisms). These were categorised under the themes: (i) ‘client characteristics’ e.g. ‘priority’ to score drugs and the ‘cost of travel’ (ii) ‘hepatitis C’ e.g. ‘no symptoms’ and fear of treatment ‘side-effects’ (iii) ‘clinic service’ e.g. ‘distance’ to the clinic and difficulty with ‘reimbursement’ of travel expenses. These mechanisms were produced within a complex context of factors including addiction, welfare policy and stigma. They were often played out in different ways and linked to other mechanisms.

41 out of 142 (29%) drug services in England ran a hepatitis C outreach clinic. There was general agreement with clients about reasons for nonattendance. However, there was some discordance, notably difficulty with walking.

This study revealed a complex picture for non-attendance in a hepatitis C outreach clinic and makes an original contribution to knowledge about the reasons for missed appointments. This in turn has informed changes to practice which may engage more people into care and treatment for example, arranging scans to be undertaken on the day of clinic appointments.