title: Fragile health status of Latino patients with diabetes seen in the emergency department of an urban, safety-net hospital.
abstract: OBJECTIVE
  Patients with diabetes presenting to safety-net emergency departments (ED) represent an at-risk population with limited resources and significant medical and social needs. We conducted a needs assessment of this group evaluating its demographic composition, health status, attitudes and beliefs about diabetes self-care and utilization of health maintenance services. We hypothesized that decreased self-efficacy and primary care use would correlate with higher glycosylated hemoglobin (HbA1C).
  
  
  METHODS
  Consecutive patients with a known history of diabetes seen in an urban, safety-net ED completed a 102-item questionnaire and had HbA1C measured. The questionnaire was developed using elements of the transtheoretical model of behavior change and self-efficacy theory.
  
  
  RESULTS
  In 230 patients enrolled, mean age was 53 years and HbA1C was 8.8%. The overwhelming majority were Hispanic, low-income, and Spanish-speaking. Major depression was common (34% prevalence). By the transtheoretical model, 81.8% demonstrated advanced readiness to change (preparation/ action stages). HbA1C varied with self-efficacy as the least empowered quartile had the highest HbA1C (9.3%) while progressively higher quartiles had lower HbA1C (9.2%, 8.3%, 8.5%, P = .03 for trend). Only 69% reported having a primary care provider (PCP) and only 3% received all ADA recommended health maintenance services. Patients with a PCP had lower HbA1C than those without a PCP (7.6% vs. 9.5%, P < .01).
  
  
  CONCLUSIONS
  In this study of largely Latino patients seen in an urban county ED, we observed extremely poor glycemic control, low diabetes-specific knowledge, high rates of major and severe major depression, low self-efficacy and unacceptably low rates of primary care and preventive health service utilization.
authors.affiliation: Department of Emergency Medicine, Keck School of Medicine of USC, Los Angeles CA 90033, USA. menchine@usc.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Menchine
authors.forename: Karl
authors.initials: K
authors.lastname: Marzec
authors.forename: Thomas
authors.initials: T
authors.lastname: Solomon
authors.forename: Sanjay
authors.initials: S
authors.lastname: Arora
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000208:ethnology*; D004636:Emergency Service, Hospital; D005260:Female; D006442:Glycated Hemoglobin; D006304:Health Status; D006630:Hispanic or Latino; D006786:Hospitals, Urban; D006801:Humans; D011446:Prospective Studies; D014505:Urban Population; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin