Experience of emergency department patients after a visit for hyperglycaemia: implications for communication and factors affecting adherence postdischarge
http://orcid.org/0000-0003-4668-5124Justin Yan1,2,
Dimah Azzam2,
Melanie Columbus2,
Kristine Van Aarsen2,
Selina Liu1,3,
Tamara Spaic1,3,
http://orcid.org/0000-0001-9551-4546Lisa Shepherd1,2,4
On behalf of the Network of Canadian Emergency Researchers
1 Medicine, Western University, Schulich School of Medicine and Dentistry, London, Ontario, Canada
2 Emergency Medicine, London Health Sciences Centre, Lawson Health Research Institute, London, Ontario, Canada
3 Endocrinology and Metabolism, St. Joseph's Healthcare London, London, Ontario, Canada
4 Centre for Education Research and Innovation, Western University, Schulich School of Medicine and Dentistry, London, ON, Canada
Correspondence to Justin Yan, Medicine, Emergency Medicine, Western University, Schulich School of Medicine and Dentistry, London, ON N6A 5C1, Canada; justin.yan{at}lhsc.on.ca
Background While studies have reported factors affecting adherence to diabetic care plans from a chronic disease perspective, no studies have addressed issues with post-discharge adherence facing patients with diabetes after an emergency department (ED) presentation for hyperglycaemia. This study's objectives were to describe patient perspectives on their experience during and after an ED visit for hyperglycaemia and to identify factors that influence postdischarge adherence.
Methods We conducted a qualitative description (QD) study of adult patients who had visited a Canadian ED for hyperglycaemia. Consistent with QD, purposive sampling was utilised, seeking diversity across age, gender and diabetes type. Participants took part in semistructured interviews and thematic analysis was used to identify and describe core themes. Frequent team meetings were held to review the analysis and to develop the final list of themes used to recode the data set. Analytic insights were tracked using reflective memos and an audit trail documented all steps and decisions.
Results 22 patients with type 1 and 2 diabetes were interviewed from June to October 2019. Participants identified several factors that impacted their ability to adhere to discharge plans: communication of instructions, psychosocial factors (financial considerations, shame and guilt, stigma and mental health), access to follow-up care and paediatric to adult care transitions.
Conclusions This study describes the patient experience with the communication of discharge instructions, as well as factors affecting adherence post-ED discharge for hyperglycaemia. Our findings suggest four strategies that could improve the patient experience, improve adherence to discharge plans and potentially decrease the frequency of recurrent ED visits for hyperglycaemia.
metabolic/diabetes/endocrine
Data are available upon reasonable request.
Handling editor Margaret Samuels-Kalow
Presented at A preliminary version of this abstract was accepted for oral presentation at the Canadian Association of Emergency Physicians' annual conference, June 2020, Ottawa, Ontario, Canada, but subsequently cancelled due to the COVID-19 pandemic.
Contributors JY conceived and designed the study. JY, KVA, MC and LS obtained research funding. JY, DA and LS designed the study and analysed the data. JY and DA undertook recruitment of participants and collected data. JY drafted the manuscript, and all authors contributed substantially to its revision. JY takes responsibility for the paper as a whole.
Funding This study was supported by a Canadian Association of Emergency Physicians' Junior Investigator Grant.
Competing interests SL reports grants and personal fees from Sanofi, grants and personal fees from NovoNordisk and personal fees from Merck outside the submitted work. TS reports personal fees from Sanofi Canada, personal fees from Novo Nordisk, personal fees from AstraZeneca, grants from Janssen, Pharmaceuticals, grants from Lexicon Pharmaceuticals, grants from Medtronic Canada, outside the submitted work.