Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2024

Open Access 01-12-2024 | Type 2 Diabetes | Research

Navigating outpatient care of patients with type 2 diabetes after hospital discharge - a qualitative longitudinal study

Authors: Léa Solh Dost, Giacomo Gastaldi, Marcelo Dos Santos Mamed, Marie P. Schneider

Published in: BMC Health Services Research | Issue 1/2024

Login to get access

Abstract

Background

The transition from hospital to outpatient care is a particularly vulnerable period for patients as they move from regular health monitoring to self-management. This study aimed to map and investigate the journey of patients with polymorbidities, including type 2 diabetes (T2D), in the 2 months following hospital discharge and examine patients’ encounters with healthcare professionals (HCPs).

Methods

Patients discharged with T2D and at least two other comorbidities were recruited during hospitalization. This qualitative longitudinal study consisted of four semi-structured interviews per participant conducted from discharge up to 2 months after discharge. The interviews were based on a guide, transcribed verbatim, and thematically analyzed. Patient journeys through the healthcare system were represented using the patient journey mapping methodology.

Results

Seventy-five interviews with 21 participants were conducted from October 2020 to July 2021. The participants had a median of 11 encounters (min–max: 6–28) with HCPs. The patient journey was categorized into six key steps: hospitalization, discharge, dispensing prescribed medications by the community pharmacist, follow-up calls, the first medical appointment, and outpatient care.

Conclusions

The outpatient journey in the 2 months following discharge is a complex and adaptive process. Despite the active role of numerous HCPs, navigation in outpatient care after discharge relies heavily on the involvement and responsibilities of patients. Preparation for discharge, post-hospitalization follow-up, and the first visit to the pharmacy and general practitioner are key moments for carefully considering patient care. Our findings underline the need for clarified roles and a standardized approach to discharge planning and post-discharge care in partnership with patients, family caregivers, and all stakeholders involved.
Appendix
Available only for authorised users
Literature
1.
Coleman EA, Boult C. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc. 2003;51(4):556–7.PubMedCrossRef
2.
Allen J, Hutchinson AM, Brown R, Livingston PM. User experience and care for older people transitioning from hospital to home: Patients’ and carers’ perspectives. Health Expect. 2018;21(2):518–27.PubMedCrossRef
3.
Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. Jama. 2007;297(8):831–41.PubMedCrossRef
4.
Allen J, Hutchinson AM, Brown R, Livingston PM. Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC Health Serv Res. 2014;14:346.PubMedPubMedCentralCrossRef
5.
Hesselink G, Flink M, Olsson M, Barach P, Dudzik-Urbaniak E, Orrego C, et al. Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers. BMJ Qual Saf. 2012;21(Suppl 1):i39-49.PubMedCrossRef
6.
World Health Organization (WHO). Transitions of Care. 2016.
7.
8.
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418–28.PubMedCrossRef
9.
Banholzer S, Dunkelmann L, Haschke M, Derungs A, Exadaktylos A, Krähenbühl S, et al. Retrospective analysis of adverse drug reactions leading to short-term emergency hospital readmission. Swiss Med Wkly. 2021;151:w20400.PubMedCrossRef
10.
World Health Organization (WHO). Medication Safety in Transitions of Care. 2019.
11.
Müller-Wieland D, Merkel M, Hamann A, Siegel E, Ottillinger B, Woker R, et al. Survey to estimate the prevalence of type 2 diabetes mellitus in hospital patients in Germany by systematic HbA1c measurement upon admission. Int J Clin Pract. 2018;72(12):e13273.PubMedCrossRef
12.
Blanc AL, Fumeaux T, Stirnemann J, Dupuis Lozeron E, Ourhamoune A, Desmeules J, et al. Development of a predictive score for potentially avoidable hospital readmissions for general internal medicine patients. PLoS One. 2019;14(7):e0219348.PubMedPubMedCentralCrossRef
13.
Hansen LO, Greenwald JL, Budnitz T, Howell E, Halasyamani L, Maynard G, et al. Project BOOST: effectiveness of a multihospital effort to reduce rehospitalization. J Hosp Med. 2013;8(8):421–7.PubMedCrossRef
14.
Khan MAB, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J. Epidemiology of Type 2 Diabetes - Global Burden of Disease and Forecasted Trends. J Epidemiol Glob Health. 2020;10(1):107–11.PubMedPubMedCentralCrossRef
15.
Iglay K, Hannachi H, Joseph Howie P, Xu J, Li X, Engel SS, et al. Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus. Curr Med Res Opin. 2016;32(7):1243–52.PubMedCrossRef
16.
Russell LB, Suh DC, Safford MA. Time requirements for diabetes self-management: too much for many? J Fam Pract. 2005;54(1):52–6.PubMed
17.
Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011;155(8):520–8.PubMedCrossRef
18.
Lussier ME, Evans HJ, Wright EA, Gionfriddo MR. The impact of community pharmacist involvement on transitions of care: a systematic review and meta-analysis. J Am Pharm Assoc. 2020;60(1):153.CrossRef
19.
Donzé J, John G, Genné D, Mancinetti M, Gouveia A, Méan M, et al. Effects of a Multimodal Transitional Care Intervention in Patients at High Risk of Readmission: The TARGET-READ Randomized Clinical Trial. JAMA Intern Med. 2023.
20.
Leppin AL, Gionfriddo MR, Kessler M, Brito JP, Mair FS, Gallacher K, et al. Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Intern Med. 2014;174(7):1095–107.PubMedPubMedCentralCrossRef
21.
Noonan VK, Lyddiatt A, Ware P, Jaglal SB, Riopelle RJ, Bingham CO 3rd, et al. Montreal Accord on Patient-Reported Outcomes (PROs) use series - Paper 3: patient-reported outcomes can facilitate shared decision-making and guide self-management. J Clin Epidemiol. 2017;89:125–35.PubMedCrossRef
22.
Hesselink G, Schoonhoven L, Barach P, Spijker A, Gademan P, Kalkman C, et al. Improving patient handovers from hospital to primary care: a systematic review. Ann Intern Med. 2012;157(6):417–28.PubMedCrossRef
23.
(WHO) WHO. Systems in the who European region: framework for action on integrated health services delivery. Copenhagen: WHO; 2016.
24.
Damery S, Flanagan S, Combes G. The effectiveness of interventions to achieve co-ordinated multidisciplinary care and reduce hospital use for people with chronic diseases: study protocol for a systematic review of reviews. Syst Revi. 2015;4(1):64.CrossRef
25.
Noor F, Gulis G, Karlsson LE. Exploration of understanding of integrated care from a public health perspective: a scoping review. J Public Health Res. 2023;12(3):22799036231181210.PubMedPubMedCentralCrossRef
26.
Jackson K, Oelke ND, Besner J, Harrison A. Patient journey: implications for improving and integrating care for older adults with chronic obstructive pulmonary disease. Can J Aging. 2012;31(2):223–33.PubMedCrossRef
27.
Gualandi R, Masella C, Viglione D, Tartaglini D. Exploring the hospital patient journey: what does the patient experience? PLoS One. 2019;14(12):e0224899.PubMedPubMedCentralCrossRef
28.
Solh Dost L, Gastaldi G, Schneider M. Patient medication management, understanding and adherence during the transition from hospital to ambulatory care – a qualitative longitudinal study in polymorbid type 2 diabetes patients. BMC Health Services Research, in press
29.
World Health Organization (WHO). Adherence to long-term therapies: Evidence for action. 2003.
30.
Fisher JD, Fisher WA, Amico KR, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006;25(4):462–73.PubMedCrossRef
31.
Bandura A. Health promotion from the perspective of social cognitive theory. Psychol Health. 1998;13(4):623–49.CrossRef
32.
33.
Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exercise Health. 2019;11(4):589–97.CrossRef
34.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
35.
Davies EL, Bulto LN, Walsh A, Pollock D, Langton VM, Laing RE, et al. Reporting and conducting patient journey mapping research in healthcare: a scoping review. J Adv Nurs. 2023;79(1):83–100.PubMedCrossRef
36.
37.
38.
39.
40.
Wong ELY, Yam CHK, Cheung AWL, Leung MCM, Chan FWK, Wong FYY, et al. Barriers to effective discharge planning: a qualitative study investigating the perspectives of frontline healthcare professionals. BMC Health Serv Res. 2011;11(1):242.PubMedPubMedCentralCrossRef
41.
Urban R, Paloumpi E, Rana N, Morgan J. Communicating medication changes to community pharmacy post-discharge: the good, the bad, and the improvements. Int J Clin Pharm. 2013;35(5):813–20.PubMedCrossRef
42.
Young E, Stickrath C, McNulty MC, Calderon AJ, Chapman E, Gonzalo JD, et al. Internal medicine residents’ perceived responsibility for patients at hospital discharge: a national survey. J Gen Intern Med. 2016;31(12):1490–5.PubMedPubMedCentralCrossRef
43.
Jones CD, Vu MB, O’Donnell CM, Anderson ME, Patel S, Wald HL, et al. A failure to communicate: a qualitative exploration of care coordination between hospitalists and primary care providers around patient hospitalizations. J Gen Intern Med. 2015;30(4):417–24.PubMedCrossRef
44.
Watts R, Pierson J, Gardner H. Co-ordination of the discharge planning process in critical care. J Clin Nurs. 2007;16(1):194–202.PubMedCrossRef
45.
Roughead EE, Kalisch LM, Ramsay EN, Ryan P, Gilbert AL. Continuity of care: when do patients visit community healthcare providers after leaving hospital? Intern Med J. 2011;41(9):662–7.PubMedCrossRef
46.
Riverin BD, Strumpf EC, Naimi AI, Li P. Optimal timing of physician visits after hospital discharge to reduce readmission. Health Serv Res. 2018;53(6):4682–703.PubMedPubMedCentralCrossRef
47.
Coppa K, Kim EJ, Oppenheim MI, Bock KR, Conigliaro J, Hirsch JS. Examination of post-discharge follow-up appointment status and 30-day readmission. J Gen Intern Med. 2021;36(5):1214–21.PubMedPubMedCentralCrossRef
48.
Haggerty JL, Roberge D, Freeman GK, Beaulieu C. Experienced continuity of care when patients see multiple clinicians: a qualitative metasummary. Ann Fam Med. 2013;11(3):262–71.PubMedPubMedCentralCrossRef
49.
Baker R, Freeman G, Boulton M, Windridge K, Tarrant C, Low J, et al. Continuity of care: patients’ and carers’ views and choices in their use of primary care services. Report for the national co-ordinating center for NHS Service Delivery and Organisation R & D (NCCSDO). 2006.
50.
Arora VM, Prochaska ML, Farnan JM, D’Arcy MJt, Schwanz KJ, Vinci LM, et al. Problems after discharge and understanding of communication with their primary care physicians among hospitalized seniors: a mixed methods study. J Hosp Med. 2010;5(7):385–91.PubMedCrossRef
51.
Allen J, Hutchinson AM, Brown R, Livingston PM. User experience and care integration in transitional care for older people from hospital to home: a meta-synthesis. Qual Health Res. 2016;27(1):24–36.PubMedCrossRef
52.
Krook M, Iwarzon M, Siouta E. The discharge process-from a patient’s perspective. SAGE Open Nurs. 2020;6:2377960819900707.PubMedPubMedCentral
53.
Huber DL, McClelland E. Patient preferences and discharge planning transitions. J Prof Nurs. 2003;19(4):204–10.PubMedCrossRef
54.
Ravenscroft E. Navigating the health care system: insights from consumers with multimorbidity. J Nurs Healthcare Chronic Illness. 2010;2:215–24.CrossRef
55.
Ancker JS, Witteman HO, Hafeez B, Provencher T, Van de Graaf M, Wei E. The invisible work of personal health information management among people with multiple chronic conditions: qualitative interview study among patients and providers. J Med Internet Res. 2015;17(6):e137.PubMedPubMedCentralCrossRef
56.
Manias E, Gerdtz M, Williams A, McGuiness J, Dooley M. Communicating about the management of medications as patients move across transition points of care: an observation and interview study. J Eval Clin Pract. 2016;22(5):635–43.PubMedCrossRef
57.
Mackie BR, Mitchell M, Marshall AP. Patient and family members’ perceptions of family participation in care on acute care wards. Scandinavian J Caring Sci. 2019;33(2):359–70.CrossRef
58.
Michelle E, Rachel CSF, Jonathan S, Priscilla H, Farrukh NJ. Telehealth-based transitional care management programme to improve access to care. BMJ Open Qual. 2023;12(4):e002495.CrossRef
59.
60.
Metadata
Title
Navigating outpatient care of patients with type 2 diabetes after hospital discharge - a qualitative longitudinal study
Authors
Léa Solh Dost
Giacomo Gastaldi
Marcelo Dos Santos Mamed
Marie P. Schneider
Publication date
01-12-2024
Publisher
BioMed Central
Keyword
Type 2 Diabetes
Published in
BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-024-10959-4

Other articles of this Issue 1/2024

BMC Health Services Research 1/2024 Go to the issue

Research

Palliative care patients in the emergency medical service: a retrospective cohort study from Finland

Research

“I want to see them thrive!”: exploring health service research priorities for young Aboriginal children growing up in Alice Springs – a qualitative study

Research

The Quality in Acute Stroke Care (QASC) global scale-up using a cascading facilitation framework: a qualitative process evaluation

Research

Influence of inventory management practices on the availability of emergency obstetric drugs in Rwandan public hospitals: a case of Rwanda Southern Province

Research

Adoption of C-reactive protein rapid tests for the management of acute childhood infections in hospitals in the Netherlands and England: a comparative health systems analysis

Research

Cross-sectional analysis of primary care clinics’ policies, practices, and availability of patient support services during the COVID-19 pandemic