title: Patients' perceptions and experiences of transitions in diabetes care: a longitudinal qualitative study.
abstract: OBJECTIVE
  To examine patients' perceptions and experiences over time of the devolvement of diabetes care/reviews from secondary to primary health-care settings.
  
  
  METHODS
  Repeat in-depth interviews with 20 patients over 4 years.
  
  
  METHODS
  Twenty type 2 diabetes patients recruited from primary- and secondary-care settings across Lothian, Scotland.
  
  
  RESULTS
  Patients' views about their current diabetes care were informed by their previous service contact. The devolvement of diabetes care/reviews to general practice was presented as a 'mixed blessing'. Patients gained reassurance from their perception that receiving practice-based care/reviews signified that their diabetes was well-controlled. However, they also expressed resentment that, by achieving good control, they received what they saw as inferior care and/or less-frequent reviews to others with poorer control. While patients tended to regard GPs as having adequate expertise to conduct their practice-based reviews, they were more ambivalent about nurses taking on this role. Opportunities to receive holistic care in general practice were not always realized due to patients seeing health-care professionals for diabetes management to whom they would not normally present for other health issues.
  
  
  CONCLUSIONS
  It is important to educate patients about their care pathways, and to reassure them that frequency of reviews depends more on clinical need than location of care and that similar care guidelines are followed in hospital clinics and general practice. A patients' history of service contact may need to be taken into account in future studies of service satisfaction.
authors.affiliation: Centre for Population Health Sciences, Community Health Sciences, The University of Edinburgh Medical School, UK. j.lawton@ed.ac.uk
authors.forename: Julia
authors.initials: J
authors.lastname: Lawton
authors.forename: David
authors.initials: D
authors.lastname: Rankin
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Peel
authors.forename: Margaret
authors.initials: M
authors.lastname: Douglas
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012606:Scotland; D006113:United Kingdom