School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK.
Int J Equity Health. 2019 Oct 11;18(1):150. doi: 10.1186/s12939-019-1061-8.
Type 1 diabetes is a complex chronic condition which requires lifelong treatment with insulin. Health outcomes are dependent on ability to self-manage the condition. Socioeconomic inequalities have been demonstrated in access to treatment and health outcomes for adults with type 1 diabetes; however, there is a paucity of research exploring how these disparities occur. This study explores the influence of socioeconomic factors in gaining access to intensive insulin regimens for adults with type 1 diabetes.
We undertook a qualitative descriptive study informed by a phenomenological perspective. In-depth face-to-face interviews were conducted with 28 patients and 6 healthcare professionals involved in their care. The interviews were analysed using a thematic approach. The Candidacy theory for access to healthcare for vulnerable groups framed the analysis.
Access to intensive insulin regimens was through hospital-based specialist services in this sample. Patients from lower socioeconomic groups had difficulty accessing hospital-based services if they were in low paid work and because they lacked the ability to navigate the healthcare system. Once these patients were in the specialist system, access to intensive insulin regimens was limited by non-alignment with healthcare professional goals, poor health literacy, psychosocial problems and poor quality communication. These factors could also affect access to structured diabetes education which itself improved access to intensive insulin regimens. Contact with diabetes specialist nurses and attendance at structured diabetes education courses could ameliorate these barriers.
Access to intensive insulin regimens was hindered for people in lower socioeconomic groups by a complex mix of factors relating to the permeability of specialist services, ability to navigate the healthcare system and patient interactions with healthcare providers. Improving access to diabetes specialist nurses and structured diabetes education for vulnerable patients could lessen socioeconomic disparities in both access to services and health outcomes.
1 型糖尿病是一种复杂的慢性疾病，需要终身使用胰岛素进行治疗。健康结果取决于自我管理疾病的能力。在 1 型糖尿病成人的治疗和健康结果方面，已经证实存在社会经济不平等现象；然而，几乎没有研究探索这些差异是如何发生的。本研究探讨了社会经济因素对 1 型糖尿病成人获得强化胰岛素治疗方案的影响。
我们进行了一项基于现象学观点的定性描述研究。对 28 名患者和 6 名参与其护理的医疗保健专业人员进行了深入的面对面访谈。使用主题分析方法对访谈进行了分析。弱势群体获得医疗保健的候选理论为分析提供了框架。
在本样本中，强化胰岛素治疗方案是通过医院专科服务获得的。来自社会经济地位较低群体的患者如果从事低薪工作并且缺乏驾驭医疗系统的能力，他们很难获得医院服务。一旦这些患者进入专科系统，获得强化胰岛素治疗方案就会受到与医疗保健专业人员目标不一致、健康素养差、心理社会问题和沟通质量差等因素的限制。这些因素也可能会影响到结构化糖尿病教育的获得，而结构化糖尿病教育本身又会改善对强化胰岛素治疗方案的获得。与糖尿病专科护士的接触和参加结构化糖尿病教育课程可以减轻这些障碍。
由于与专科服务的渗透性、驾驭医疗系统的能力以及患者与医疗保健提供者之间的互动有关的一系列复杂因素，社会经济地位较低群体获得强化胰岛素治疗方案的机会受到了阻碍。为弱势患者增加糖尿病专科护士和结构化糖尿病教育的机会可以减少服务和健康结果方面的社会经济差距。
