Adults with type 1 diabetes: what factors are associated with disengagement from health services?

Elders, Vera; Keen, Andrew; Gold, Ann

doi:10.1002/pdi.1845

Cited by 5 publications

(11 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study provided a more nuanced understanding of this barrier since it revealed the financial implications for individuals in low skilled and low paid jobs taking time off work for hospital appointments. The findings also resonate with a recent study which found that individuals with type 1 diabetes in the most deprived categories were more frequently disengaged from healthcare services [49] . In our study issues relating to transport impeded some individuals’ attendance at specialist services and these findings are consistent with studies which have found transport is an important barrier to accessing services for lower socioeconomic groups [29].…”

Section: Discussionsupporting

confidence: 87%

Socioeconomic disparities in access to intensive insulin regimens for adults with type 1 diabetes: a qualitative study of patient and healthcare professional perspectives

Scott

O’Cathain

Goyder

2019

Int J Equity Health

View full text Add to dashboard Cite

Background 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. Methods 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. Results 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. Conclusions 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.

show abstract

Section: Discussionsupporting

confidence: 87%

Socioeconomic disparities in access to intensive insulin regimens for adults with type 1 diabetes: a qualitative study of patient and healthcare professional perspectives

Scott

O’Cathain

Goyder

2019

Int J Equity Health

View full text Add to dashboard Cite

show abstract

“…Reported baseline non‐attendance rates at diabetes appointments were mostly between 10 and 30% , but the extreme ranges were 8.3 and 76% . The means of quantifying non‐attendance varied; some studies calculated the number of missed appointments as a percentage of total booked appointments .…”

Section: Resultsmentioning

confidence: 99%

“…The means of quantifying non‐attendance varied; some studies calculated the number of missed appointments as a percentage of total booked appointments . Non‐attendance was also determined as the number of people missing more than one appointment in a defined period or when there was no record of HbA 1c measurement in primary or secondary care in the previous 12–15 months . Re‐referred ‘lapsers’ made up 19% of the ‘new patient’ clinic load at one UK diabetes service and appointment cancellations were only defined as a separate entity in one study where they occurred more frequently than non‐attendance (18 vs. 12%) .…”

Section: Resultsmentioning

confidence: 99%

“…A number of demographic factors including unemployment , financial pressures , smoking , increased alcohol intake and parenthood, in particular being a single parent , were associated with non‐attendance. By contrast, social deprivation was only mildly associated with non‐attendance in one Scottish study .…”

Section: Resultsmentioning

confidence: 99%

“…Thirty‐four studies of varying designs were identified (15 observational, 1 randomized control trial, 9 qualitative, 5 surveys, 4 service improvements). Sixteen were studies from the UK , four from Europe , six from North America and eight from the rest of the world . Six studies specifically focused on young adults in transition from paediatric to adult services, each of which had a mean participant age of >18 years (age range 15–30 years) .…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Non‐attendance at diabetes outpatient appointments: a systematic review

et al. 2020

View full text Add to dashboard Cite

Background Non-attendance at diabetes outpatient appointments is a sizeable problem worldwide and has been associated with suboptimal health outcomes. We aimed to describe the characteristics, health outcomes and reasons given for non-attendance at doctor-or nurse-led diabetes appointments, and interventions to improve attendance. Methods PubMed, EMBASE, CINAHL and PsychInfo were searched from database inception to February 2019. Included articles were peer-reviewed, published in English, related to adults or young people with type 1 or type 2 diabetes, and addressed one of the above aspects of non-attendance. Studies were excluded if reporting on other types of diabetes or reviewing attendance at structured education, retinal screening, paediatric, antenatal, podiatry or dietetic clinics. Results Thirty-four studies of varied designs were identified (15 observational, 1 randomized control trial, 9 qualitative, 5 surveys, 4 service improvements). The definition of non-attendance varied. Younger adults, smokers and those with financial pressures were less likely to attend. Non-attendance was associated with higher HbA 1c ; other outcomes were varied but typically worse in non-attenders. Reasons for non-attendance in qualitative studies fell into three categories: balancing the costs and benefits of attendance, coping strategies, and the relationships between the person with diabetes and healthcare professionals. Interventions included appointment management strategies, service improvements, patient navigators and WebCam appointments. Conclusions Non-attendance is only partially explained by logistical issues. Qualitative studies suggest complex psychosocial factors are involved. Interventions have progressed from simple appointment reminders in an attempt to address some of the psycho-social determinants, but more work is needed to improve attendance.

show abstract

International comparison of glycaemic control in people with type 1 diabetes: an update and extension

et al. 2021

View full text Add to dashboard Cite

To update and extend a previous cross-sectional international comparison of glycaemic control in people with type 1 diabetes. Methods: Data were obtained for 520,392 children and adults with type 1 diabetes from 17 population and five clinic-based data sources in countries or regions between 2016 and 2020. Median HbA 1c (IQR) and proportions of individuals with HbA 1c < 58 mmol/mol (<7.5%), 58-74 mmol/mol (7.5-8.9%) and ≥75 mmol/mol (≥9.0%) were compared between populations for individuals aged <15, 15-24 and ≥25 years. Logistic regression was used to estimate the odds ratio (OR) of HbA 1c < 58 mmol/mol (<7.5%) relative to ≥58 mmol/mol (≥7.5%), stratified and adjusted for sex, age and data source. Where possible, changes in the proportion of individuals in each HbA 1c category compared to previous estimates were calculated.Results: Median HbA 1c varied from 55 to 79 mmol/mol (7.2 to 9.4%) across data sources and age groups so a pooled estimate was deemed inappropriate. OR (95% CI) for HbA 1c < 58 mmol/mol (<7.5%) were 0.91 (0.90-0.92) for women 18 Joint municipal authority for North Karelia social and health services (Siunsote),

show abstract

Adults with type 1 diabetes: what factors are associated with disengagement from health services?

Cited by 5 publications

References 6 publications

Socioeconomic disparities in access to intensive insulin regimens for adults with type 1 diabetes: a qualitative study of patient and healthcare professional perspectives

Socioeconomic disparities in access to intensive insulin regimens for adults with type 1 diabetes: a qualitative study of patient and healthcare professional perspectives

Non‐attendance at diabetes outpatient appointments: a systematic review

International comparison of glycaemic control in people with type 1 diabetes: an update and extension

Contact Info

Product

Resources

About