Patient perspectives on discharge from specialist type 2 diabetes care back to primary care: a qualitative study

Heidi Dutton, Margo S Rowan, Clare Liddy, Julie Maranger, Teik Chye Ooi, Janine Malcolm, Erin Keely
Canadian Journal of Diabetes 2014, 38 (3): 191-7

BACKGROUND: Timely access to specialist care remains a barrier for both patients with type 2 diabetes and their primary care physicians. To improve access to specialists for new patients, an efficient and appropriate discharge process is required. Consideration of patient perspectives is central to developing a smooth care transition, and currently, research in this area is limited. The aim of this study was to explore patients' expectations and experiences surrounding discharge from a specialized diabetes centre back to primary care.

METHODS: A qualitative approach was used involving data from one-to-one semistructured interviews. Participants were 12 patients with type 2 diabetes who had been discharged from the Tertiary Care Diabetes Referral Centre in Ottawa, Canada.

RESULTS: Participants were uncertain in their initial expectations of specialist care duration. Patients expressed that an explicit discussion of the discharge process had not occurred, and many were unclear about the reason for discharge and plans for appropriate primary care physician follow up. Patients' psychological preparedness for discharge existed on a spectrum from low to high readiness. Many articulated a desire for improved communication surrounding the discharge plan, and some wished to have input into the discharge decision. Although most described their primary care physician positively, some expressed concern over cessation of specialist care.

CONCLUSIONS: It is important to prepare patients for discharge from care, and to recognize that individual patients have varying needs and preferences. Further research is warranted to develop effective interventions for improving the discharge process for patients.

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