Progression to unscheduled hospital admissions in people with diabetes: a qualitative interview study.
diabetes mellitus
emergency service, hospital
prevention
qualitative research
Journal
BJGP open
ISSN: 2398-3795
Titre abrégé: BJGP Open
Pays: England
ID NLM: 101713531
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
10
03
2021
accepted:
15
03
2021
pubmed:
30
4
2021
medline:
30
4
2021
entrez:
29
4
2021
Statut:
epublish
Résumé
People with diabetes often have difficulty maintaining optimal blood glucose levels, risking progressive complications that can lead to unscheduled care. Unscheduled care can include attending emergency departments, ambulance callouts, out-of-hours care, and non-elective hospital admissions. A large proportion of non-elective hospital admissions involve people with diabetes, with significant health and economic burden. To identify precipitating factors influencing diabetes-related unscheduled hospital admissions, exploring potential preventive strategies to reduce admissions. Thirty-six people with type 1 ( Factors precipitating admissions were examined using framework analysis. Three aspects of care influenced unscheduled admissions: perceived inadequate knowledge of diabetes complications; restricted provision of care; and complexities in engagement with self-care and help-seeking. Limited specialist professional knowledge of diabetes by staff in primary and community care, alongside inadequate patient self-management knowledge, led to inappropriate treatment and significant delays. This was compounded by restricted provision of care, characterised by poor access to services - in time and proximity - and poor continuity of care. Complexities in patient engagement, help-seeking, and illness beliefs further complicated the progression to unscheduled admissions. Dedicated investment in primary care is needed to enhance provision of and access to services. There should be increased promotion and earlier diabetes specialist team involvement, alongside training and use of technology and telemedicine, to enhance existing care.
Sections du résumé
BACKGROUND
BACKGROUND
People with diabetes often have difficulty maintaining optimal blood glucose levels, risking progressive complications that can lead to unscheduled care. Unscheduled care can include attending emergency departments, ambulance callouts, out-of-hours care, and non-elective hospital admissions. A large proportion of non-elective hospital admissions involve people with diabetes, with significant health and economic burden.
AIM
OBJECTIVE
To identify precipitating factors influencing diabetes-related unscheduled hospital admissions, exploring potential preventive strategies to reduce admissions.
DESIGN & SETTING
METHODS
Thirty-six people with type 1 (
METHOD
METHODS
Factors precipitating admissions were examined using framework analysis.
RESULTS
RESULTS
Three aspects of care influenced unscheduled admissions: perceived inadequate knowledge of diabetes complications; restricted provision of care; and complexities in engagement with self-care and help-seeking. Limited specialist professional knowledge of diabetes by staff in primary and community care, alongside inadequate patient self-management knowledge, led to inappropriate treatment and significant delays. This was compounded by restricted provision of care, characterised by poor access to services - in time and proximity - and poor continuity of care. Complexities in patient engagement, help-seeking, and illness beliefs further complicated the progression to unscheduled admissions.
CONCLUSION
CONCLUSIONS
Dedicated investment in primary care is needed to enhance provision of and access to services. There should be increased promotion and earlier diabetes specialist team involvement, alongside training and use of technology and telemedicine, to enhance existing care.
Identifiants
pubmed: 33910915
pii: BJGPO.2021.0044
doi: 10.3399/BJGPO.2021.0044
pmc: PMC8450884
pii:
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
Copyright © 2021, The Authors.
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