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

• Published in: The American journal of the medical sciences Vol. 351; no. 4; pp. 400 - 406
• Main Authors: Shearer, Jennifer E., PhD, RN, Jenkins, Carolyn H., DrPH, MS, Magwood, Gayenell S., PhD, RN, Pope, Charlene A., PhD, MPH, RN
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2016; Copyright by the Southern Society for Clinical Investigation. Unauthorized reproduction of this article is prohibited
• Subjects: Adult; Aged; Aged, 80 and over; Ambulatory Care - statistics & numerical data; Ambulatory-sensitive conditions; Decision Making; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - psychology; Diabetes Mellitus, Type 2 - therapy; Emergency department use; Emergency Service, Hospital - statistics & numerical data; Female; Grounded Theory; Grounded theory with dimensional analysis; Humans; Internal Medicine; Male; Middle Aged; Qualitative research; Surveys and Questionnaires; Type 2 diabetes; Type 2 diabetes; Qualitative research; Grounded theory with dimensional analysis; Ambulatory-sensitive conditions; Emergency department use
• ISSN: 0002-9629; 1538-2990
• DOI: 10.1016/j.amjms.2016.01.007

Abstract Background Approximately 21 million persons have diabetes and account for 11.9% of all emergency department (ED) visits for a total cost of $14.1 billion. Nonemergent 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 approximately 30% of South Carolina׳s population but make up approximately 50% of the ED visits for diabetes. The purpose of the research was to explore the experiences of 20 African-American adults with diabetes with ambulatory-sensitive ED use. Research Design and Methods The research design for this study is grounded theory with dimensional analysis methods. Following ethics approval and informed consent, interviews were conducted, 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.