Mylhousen Emily M, Tolley Elizabeth A, Surbhi Satya, Bailey James E
Center for Health System Improvement, The University of Tennessee Health Science Center, Memphis, USA.
Preventive Medicine, The University of Tennessee Health Science Center, Memphis, USA.
Cureus. 2022 Mar 1;14(3):e22756. doi: 10.7759/cureus.22756. eCollection 2022 Mar.
The management of diabetes, like many other chronic conditions, depends on effective primary care engagement. Patients with diabetes without a usual source of care have a higher risk of uncontrolled disease, hospitalizations, and early death. Our objective was to study the effect of a brief intervention to help patients in medically underserved areas obtain rapid primary care follow-up appointments following hospitalization. We performed a pilot pragmatic randomized controlled trial of adult patients with uncontrolled diabetes who had been admitted to one of three hospitals in the Memphis, TN, area. The enhanced usual care arm received a list of primary care clinics, whereas the intervention group had an appointment made for them preceding their index discharge. Patients in both groups were evaluated for primary care appointment attendance within seven and fourteen days of index discharge. In addition, we examined barriers patients encounter to receiving rapid primary care follow-up using a secret shopper approach to assess wait times when calling primary care offices. Twelve patients were enrolled with six in each trial arm. Baseline demographics, access to medical care, and health literacy were similar across the groups. Primary care follow-up was also similar across the groups; no improvements in follow-up rates were seen in the group receiving assistance with making appointments. Identified barriers to making primary care follow-up appointments included inability to schedule an urgent appointment, long hold times when calling doctor's offices and lack of transportation. Additionally, hold times when calling primary care offices were found to be excessively long in the medically underserved areas studied. The study demonstrates the feasibility of providing patient assistance with scheduling rapid primary care follow-up appointments at the time of discharge and the potential to improve care transitions and access to primary care among patients living in medically underserved areas. Larger pragmatic trials are needed to further test alternative approaches for insuring rapid primary care follow-up in vulnerable patients with ambulatory care-sensitive chronic conditions.
与许多其他慢性病一样，糖尿病的管理依赖于有效的初级保健参与。没有常规医疗服务来源的糖尿病患者，疾病控制不佳、住院和过早死亡的风险更高。我们的目标是研究一种简短干预措施的效果，以帮助医疗服务不足地区的患者在住院后迅速获得初级保健随访预约。我们对田纳西州孟菲斯地区三家医院之一收治的成年未控制糖尿病患者进行了一项实用性随机对照试验。强化常规护理组收到一份初级保健诊所名单，而干预组在其出院前就为他们安排了预约。两组患者在出院后的7天和14天内接受初级保健预约就诊情况评估。此外，我们采用秘密顾客方法评估拨打初级保健办公室时的等待时间，以检查患者在接受快速初级保健随访时遇到的障碍。共招募了12名患者，每个试验组6名。各组的基线人口统计学、医疗服务可及性和健康素养相似。各组的初级保健随访情况也相似；在接受预约协助的组中，随访率没有提高。确定的初级保健随访预约障碍包括无法安排紧急预约、拨打医生办公室时等待时间长以及缺乏交通。此外，在所研究的医疗服务不足地区，拨打初级保健办公室的等待时间过长。该研究证明了在出院时为患者提供快速初级保健随访预约安排协助的可行性，以及改善医疗服务过渡和提高医疗服务不足地区患者获得初级保健机会的潜力。需要进行更大规模的实用性试验，以进一步测试确保对患有门诊护理敏感慢性病的脆弱患者进行快速初级保健随访的替代方法。
