RESUMO
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.
Assuntos
Diabetes Mellitus Tipo 2 , Alta do Paciente , Humanos , Assistência ao Convalescente , Estudos Longitudinais , Assistência Ambulatorial , Pesquisa Qualitativa , HospitaisRESUMO
Diabetes self-management (DSM) is a process based on a series of complex learnings. The conceptualization of the role of the emotional dimensions that underlie and structure this process is critical to better understand why living with diabetes can become a burden. A clinical case illustrates the intertwining of the affective and cognitive dimensions of diabetes burden and its influence on DSM skills. Emotional regulation is a recognized determinant to implement effective and long-term DSM skills as well as access to DSM interventions. In order to improve DSME/S interventions efficacy, the role of emotional dimensions, new technologies and therapeutic advances needs to be considered.
L'autogestion du diabète sucré (AGDM) est un processus basé sur une série d'apprentissages complexes. La conceptualisation du rôle des dimensions affectives qui sous-tendent et structurent ce processus permet d'appréhender différemment le vécu des patients avec un diabète sucré. Une vignette clinique illustre l'intrication des dimensions affectives et cognitives et les possibles conséquences sur l'AGDM. La régulation des émotions s'avère être un des facteurs déterminants de l'AGDM, tout comme l'accès à des dispositifs d'éducation thérapeutique du patient (ETP). La prise en compte du rôle respectif des dimensions émotionnelles, des nouvelles technologies et des avancées thérapeutiques sur l'AGDM est à considérer pour développer des dispositifs d'ETP performants.
Assuntos
Diabetes Mellitus/terapia , Autocuidado , Autogestão , Diabetes Mellitus/psicologia , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Regulação Emocional , HumanosRESUMO
Learning to live with a chronic condition is one of the greatest challenges regarding health today, either at individual or societal level. Type 1 diabetes affecting young people and their family raises new care delivery. Proximity structures, inserted into the regional network, accessible and responsive to the needs of patients and their families, are thus promising to encourage empowerment in persons affected by a chronic disease as well as in their entourage.
Apprendre à vivre avec une maladie chronique est un des défis majeurs auxquels est confronté le monde de la santé aujourd'hui, tant au plan de l'individu que de la société dans son ensemble. Le diabète de type 1, qui touche des individus jeunes et leur entourage, suscite le développement de nouvelles offres de soins. Ainsi, des structures de proximité, insérées dans le réseau régional, faciles d'accès et répondant aux besoins des patients et de leur entourage, sont prometteuses car elles favorisent le processus d'autonomisation tant chez les personnes concernées que leur entourage.
Assuntos
Atenção à Saúde/organização & administração , Diabetes Mellitus Tipo 1/terapia , Acessibilidade aos Serviços de Saúde , Criança , Necessidades e Demandas de Serviços de Saúde , HumanosRESUMO
Type 1 diabetes management is a highly demanding task that largely falls on people with diabetes, their family, and their peers. Diabetes self-management education and support aim at increasing knowledge, skills, and confidence to take appropriate diabetes management decisions. The current evidence shows that efficient diabetes self-management relies on person-centered interventions and a team of pluri-disciplinary educators with expertise in diabetes care and education. The irruption of the COVID-19 pandemic has increased diabetes burden and the need to offer remote diabetes self-management education services. The present article offers a perspective about expectations and quality issues related to the implementation of a remote version of the FIT course, a validated structured diabetes management educational program.