Finally, it must be noted that the delivery of this intervention was challenging and time consuming, due in part to the difficulties in accessing participants despite repeated efforts. Clinicians and service planners will recognize the existence of a hard-to-reach group of high-risk patients who frequently require unplanned care with repeated hospital admissions to deal with the complications of poor control. Continued persistence and flexibility may be the solution to accessing these vulnerable populations in both research and clinical settings, although these interventions initially may be more costly and time consuming. In the long term, such interventions may improve illness outcomes for patients, thereby reducing costs and improving quality of life for patients and families. - See more at: http://www.ajmc.com/publications/issue/2011/2011-2-vol17-n2/ajmc_11feb_keogh_105to113/3#sthash.0zrLIpxB.dpuf