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


METHODS
Surveys of hospital inpatients.


METHODS
Urban hospital


METHODS
Inpatients with diabetes mellitus.


METHODS
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).


CONCLUSIONS
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.
Crawford Long Hospital , Atlanta, Georgia, USA.
Kate
K
Wheeler
Rochanda
R
Crawford
Debra
D
McAdams
Rosa
R
Robinson
Virginia G
VG
Dunbar
Curtiss B
CB
Cook
D001741:Black or African American; D003266:Continuity of Patient Care; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010360:Patient Transfer; D014481:United States; D014505:Urban Population