Contested Ownership of Disease and Ambulatory-Sensitive Emergency Department Visits for Type 2 Diabetes

Abstract

Background About 21 million persons have diabetes and account for 11.9% of all emergency department visits for a total cost of $14.1 billion. Non-emergent visits for ambulatory sensitive conditions that could be managed by the primary care provider make up almost one third of the ED visits. African Americans comprise about 30% of South Carolina's population but make up about 50% of the ED visits for diabetes. Methods The research design was a qualitative study using grounded theory with dimensional analysis methods to explore reasons African American patients used the ED for ambulatory sensitive conditions. Research Design The research design for this study is grounded theory with dimensional analysis methods to explore the experiences of 20 African American adults with diabetes with ambulatory sensitive ED use. Following informed consent, interviews were recorded and transcribed verbatim, and themes were analyzed to form the explanatory framework or matrix for ED use. The framework of context, conditions, processes, and consequences provides a key for understanding the themes of the story embedded in the descriptive narratives Results The contested ownership of diabetes was the overarching perspective –“doing what I got to do,” “it's always on mind...wishing not to be a diabetic,” and “it's a constant burden.” And handling diabetes involved taking decisions “into your hands.” The context of perceived urgency of symptoms included all the reasons that precipitated ED visit—personal experience, primary care access and services, and social network support for decisions influenced ownership of these decisions.

Characteristics of Health-related Text Messages Preferred by Medically Underserved African-American Patients with Diabetes

“…This study is among the first to show these patients were most interested in receiving text messages that are personalized and tailored to their interests and self-care needs. Participants’ interest in handling their disease management and improving their health outcomes is consistent with the concept of ownership of diabetes as described by Shearer and colleagues [25]. We found that a majority of the medically underserved patients in this study sample already use mobile phones for personal text messaging and are highly interested in receiving health-related text messages from their doctor’s office.…”

Social determinants of ambulatory care sensitive conditions: a qualitative meta-synthesis based on patient perspectives

“…The total unique number of patients in the nine studies was 167, ranging from 3 to 90 patients per study. All studies investigated ACSC hospitalizations except one that studied ACSC ED visits ( 23 ). Two studies used a mixed-method study design ( 24 , 25 ).…”

“…The majority of the patients were middle-aged and older. Four studies provided the race/ethnicity of their patients ( 22 , 23 , 27 , 28 ), while other studies discussed patients' income or poor neighborhoods ( 21 – 23 ), indicating that patients were socially vulnerable. Two studies did not provide a gender distribution of patients ( 23 , 26 ).…”

A Community‐Engaged Assessment of Barriers and Facilitators to Rapid Stroke Treatment

“…Sometimes, limited understanding resulted in lack of ownership of symptoms. The ownership of symptoms is complex; the experience of health care disparities may influence the decisions to act on symptoms (Shearer, Jenkins, Magwood, & Pope, ). As described by one family member: “I guess with some people they are afraid to hear what the doctor have to say.…”