title: Patient perspectives on discharge from specialist type 2 diabetes care back to primary care: a qualitative study.
abstract: BACKGROUND
  Timely access to specialist care remains a barrier for both patients with type 2 diabetes and their primary care physicians. To improve access to specialists for new patients, an efficient and appropriate discharge process is required. Consideration of patient perspectives is central to developing a smooth care transition, and currently, research in this area is limited. The aim of this study was to explore patients' expectations and experiences surrounding discharge from a specialized diabetes centre back to primary care.
  
  
  METHODS
  A qualitative approach was used involving data from one-to-one semistructured interviews. Participants were 12 patients with type 2 diabetes who had been discharged from the Tertiary Care Diabetes Referral Centre in Ottawa, Canada.
  
  
  RESULTS
  Participants were uncertain in their initial expectations of specialist care duration. Patients expressed that an explicit discussion of the discharge process had not occurred, and many were unclear about the reason for discharge and plans for appropriate primary care physician follow up. Patients' psychological preparedness for discharge existed on a spectrum from low to high readiness. Many articulated a desire for improved communication surrounding the discharge plan, and some wished to have input into the discharge decision. Although most described their primary care physician positively, some expressed concern over cessation of specialist care.
  
  
  CONCLUSIONS
  It is important to prepare patients for discharge from care, and to recognize that individual patients have varying needs and preferences. Further research is warranted to develop effective interventions for improving the discharge process for patients.
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Heidi
authors.initials: H
authors.lastname: Dutton
authors.affiliation: Department of Family Medicine, University of Ottawa, Ottawa, Canada; Rowan Research and Evaluation, Ottawa, Ontario, Canada.
authors.forename: Margo S
authors.initials: MS
authors.lastname: Rowan
authors.affiliation: Department of Family Medicine, University of Ottawa, Ottawa, Canada; C.T. Lamont Primary Health Care Research Centre, Ottawa, Canada.
authors.forename: Clare
authors.initials: C
authors.lastname: Liddy
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Maranger
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Teik Chye
authors.initials: TC
authors.lastname: Ooi
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Janine
authors.initials: J
authors.lastname: Malcolm
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Canada; Rowan Research and Evaluation, Ottawa, Ontario, Canada. Electronic address: ekeely@ottawahospital.on.ca.
authors.forename: Erin
authors.initials: E
authors.lastname: Keely
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards*; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration; D036301:Qualitative Research; D012017:Referral and Consultation; D013038:Specialization; D011795:Surveys and Questionnaires
keywords: adaptation des soins; care transitions; congé; diabète de type 2; discharge; expérience des patients; patient experiences; qualitatif; qualitative; type 2 diabetes