title: Considering quality of care for young adults with diabetes in Ireland.
abstract: BACKGROUND
  Research on the quality of diabetes care provided to young adults with Type 1 diabetes is lacking. This study investigates perceptions of quality of care for young adults with Type 1 diabetes (23-30 years old) living in the Republic of Ireland.
  
  
  METHODS
  Thirty-five young adults with Type 1 diabetes (twenty-nine women, six men) and thirteen healthcare professionals (ten diabetes nurse specialists, three consultant Endocrinologists) were recruited. All study participants completed semi-structured interviews that explored their perspectives on the quality of diabetes services in Ireland. Interviews were analyzed using standard qualitative thematic analysis techniques.
  
  
  RESULTS
  Most interviewees identified problems with Irish diabetes services for young adults. Healthcare services were often characterised by long waiting times, inadequate continuity of care, overreliance on junior doctors and inadequate professional-patient interaction times. Many rural and non-specialist services lacked funding for diabetes education programmes, diabetes nurse specialists, insulin pumps or for psychological support, though these services are important components of quality Type 1 diabetes healthcare. Allied health services such as psychology, podiatry and dietician services appeared to be underfunded in many parts of the country. While Irish diabetes services lacked funding prior to the recession, the economic decline in Ireland, and the subsequent austerity imposed on the Irish health service as a result of that decline, appears to have additional negative consequences. Despite these difficulties, a number of specialist healthcare services for young adults with diabetes seemed to be providing excellent quality of care. Although young adults and professionals identified many of the same problems with Irish diabetes services, professionals appeared to be more critical of diabetes services than young adults. Young adults generally expressed high levels of satisfaction with services, even where they noted that aspects of those services were sub-optimal.
  
  
  CONCLUSIONS
  Good quality care appears to be unequally distributed throughout Ireland. National austerity measures appear to be negatively impacting health services for young adults with diabetes. There is a need for more Endocrinologist and diabetes nurse specialist posts to be funded in Ireland, as well as allied health professional posts.
authors.affiliation: Department of Public Health Medicine and Epidemiology, Royal College of Surgeons in Ireland, St, Stephen's Green, Dublin, Ireland. mylesbalfe@rcsi.ie.
authors.forename: Myles
authors.initials: M
authors.lastname: Balfe
authors.forename: Ruairi
authors.initials: R
authors.lastname: Brugha
authors.forename: Diarmuid
authors.initials: D
authors.lastname: Smith
authors.forename: Seamus
authors.initials: S
authors.lastname: Sreenan
authors.forename: Frank
authors.initials: F
authors.lastname: Doyle
authors.forename: Ronan
authors.initials: R
authors.lastname: Conroy
mesh_terms: D000328:Adult; D003142:Communication; D003266:Continuity of Patient Care; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007494:Ireland; D008297:Male; D010353:Patient Education as Topic / Q000592:standards; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D014850:Waiting Lists; D055815:Young Adult