Medicine, Western University, Schulich School of Medicine and Dentistry, London, Ontario, Canada
Emergency Medicine, London Health Sciences Centre, Lawson Health Research Institute, London, Ontario, Canada.
Emerg Med J. 2022 Feb;39(2):132-138. doi: 10.1136/emermed-2020-210677. Epub 2021 May 4.
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.
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.
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.
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.
虽然有研究从慢性病的角度报告了影响糖尿病护理计划依从性的因素，但没有研究解决糖尿病患者因高血糖在急诊科就诊后的出院后依从性问题。本研究的目的是描述患者在急诊科就诊期间和之后对其经历的看法，并确定影响出院后依从性的因素。
我们对因高血糖在加拿大急诊科就诊的成年患者进行了定性描述（QD）研究。与 QD 一致，我们采用了目的性抽样，在年龄、性别和糖尿病类型方面寻求多样性。参与者参加了半结构化访谈，使用主题分析来确定和描述核心主题。我们经常举行团队会议，以审查分析结果，并制定用于重新编码数据集的最终主题列表。使用反思性备忘录跟踪分析见解，并记录所有步骤和决策的审核跟踪。
2019 年 6 月至 10 月期间，我们对 22 名 1 型和 2 型糖尿病患者进行了访谈。参与者确定了几个影响他们遵守出院计划能力的因素：医嘱沟通、心理社会因素（经济考虑、羞耻感和内疚感、污名和心理健康）、获得后续护理以及儿科到成人护理的过渡。
本研究描述了患者对出院医嘱沟通的体验，以及影响高血糖急诊科出院后依从性的因素。我们的研究结果表明，有四种策略可以改善患者的体验，提高出院计划的依从性，并可能降低因高血糖而反复到急诊科就诊的频率。
