Jackson Bianca M, Gutierrez Mary Lou, Relyea George E, Carlton Erik L, Ahn SangNam, Binkley Bonnie L, Bailey James E
Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, TN, USA.
Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA.
Health Serv Res Manag Epidemiol. 2017 May 11;4:2333392817702760. doi: 10.1177/2333392817702760. eCollection 2017 Jan-Dec.
Diabetic patients with multimorbidity in medically underserved minority communities are less engaged in primary care and experience high emergency department (ED) utilization. This study assesses unmet primary care needs among diabetic patients in a medically underserved area (MUA).
A suburb of Memphis-Whitehaven, Tennessee (Shelby County, ZIP codes 38109 and 38116)-majority African American (96.6%) with 30.5% below the poverty level.
Community case study using multiple data sources including diabetes registry, individual interviews, focus groups, and a survey of 30 ED patients with diabetes and multimorbidity.
Diabetes registry data indicated that 95.5% of 5723 diabetic patients had multimorbidity. Over 91.5% were uncontrolled at some point in 2014 to 2015. Only 83% of patients with diabetes and multimorbidity reported having a primary care provider (PCP) and those without a PCP were more likely to report delays in needed care. Patients expressed strong interest in health coaching (88%) and receiving text messages from the doctor's office (73%). Individual patient interviews (n = 9) and focus groups (n = 11) revealed common primary care and self-care experiences and needs including diabetes education, improved patient-provider communication, health-care access and coverage, and strengthened primary care and community.
This study demonstrates that almost 1 in 5 ED complex diabetic patients in an MUA do not have a PCP, and that difficulty accessing primary care often results in patients forgoing needed care. Qualitative findings support these conclusions. These results suggest that primary care capacity and infrastructure to support diabetes self-care need strengthening in MUAs.
在医疗服务不足的少数族裔社区中，患有多种疾病的糖尿病患者较少参与初级保健，且急诊室（ED）利用率较高。本研究评估了医疗服务不足地区（MUA）糖尿病患者未满足的初级保健需求。
田纳西州孟菲斯市怀特黑文的一个郊区（谢尔比县，邮政编码38109和38116），多数为非裔美国人（96.6%），30.5%的人口生活在贫困线以下。
采用社区案例研究，使用多种数据来源，包括糖尿病登记册、个人访谈、焦点小组以及对30名患有糖尿病和多种疾病的急诊患者的调查。
糖尿病登记数据显示，5723名糖尿病患者中有95.5%患有多种疾病。在2014年至2015年的某个时间点，超过91.5%的患者病情未得到控制。在患有糖尿病和多种疾病的患者中，只有83%的人报告有初级保健医生（PCP），而没有初级保健医生的患者更有可能报告所需护理的延迟。患者对健康指导（88%）和接收医生办公室的短信（73%）表现出浓厚兴趣。个体患者访谈（n = 9）和焦点小组（n = 11）揭示了常见的初级保健和自我保健经历及需求，包括糖尿病教育、改善患者与医疗服务提供者的沟通、医疗保健的可及性和覆盖范围，以及加强初级保健和社区建设。
本研究表明，在一个医疗服务不足地区，近五分之一的急诊复杂糖尿病患者没有初级保健医生，且获得初级保健的困难往往导致患者放弃所需护理。定性研究结果支持这些结论。这些结果表明，在医疗服务不足地区，支持糖尿病自我护理的初级保健能力和基础设施需要加强。
