Inpatient to outpatient transfer of diabetes care: perceptions of barriers to postdischarge followup in urban African American patients.

OBJECTIVES: To determine potential obstacles to postdischarge followup of hospitalized diabetes patients and to inform planning to better ensure continuity of service when care is transferred from inpatient to outpatient settings. DESIGN: Surveys of hospital inpatients. SETTING: Urban hospital PATIENTS: Inpatients with diabetes mellitus. MAIN OUTCOME MEASURES: Identification of barriers to postdischarge followup in relation to age, sex, race, marital status, employment status, educational level, health insurance status, date of admission, date of diagnosis, admission and discharge glucose values, and hyperglycemia medications at discharge. RESULTS: Of 303 respondents (average age 50 years, 46% women, 91% African American), 95% indicated that they planned to use follow-up services. Fifty percent of these patients anticipated encountering barriers to keeping outpatient appointments. The primary reasons were transportation problems (59%), inability to afford the visit (34%), and lack of health insurance (24%). Among persons expecting difficulty with follow-up care, significantly more were uninsured (P=.025), and a greater proportion had prior trouble accessing medical care (P<.0001). The odds of anticipating a barrier to postdischarge followup were higher for persons without health insurance (odds ratio [OR] 2.62, P=.040) and for persons with prior healthcare access problems (OR 5.94, P<.0001). Women also had a greater chance of reporting an obstacle (OR 2.30, P=.024). CONCLUSION: New discharge planning programs that emphasize the need for long-term followup and that assist persons with access to postdischarge medical services should be developed, particularly for minority populations at particular risk for diabetes and its complications.