title: 'Well, who do I phone?' Preparing for urgent care: a challenge for patients and service providers alike'.
abstract: OBJECTIVE
  To investigate factors influencing patients' self-management of urgent diabetes problems that precipitated unscheduled hospital care.
  
  
  BACKGROUND
  Diabetes is placing increasing resource demands on health services and current policy advocates management in primary care and community settings whenever possible. Such policy has implications for patient education and empowerment and on mechanisms within primary and community care to support the management of diabetes when urgent healthcare problems arise.
  
  
  METHODS
  Qualitative, descriptive investigation, across two contrasting sites.
  
  
  METHODS
  Forty-five people admitted to hospital for urgent/emergency care due to diabetes-related problems were recruited from urban and rural localities in the UK. Semi-structured interviews were conducted and data analysed using nvivo version 8 and framework techniques.
  
  
  RESULTS
  Self-management of diabetes was typically habitual, and urgent problems that proved difficult to resolve necessitated recourse to unscheduled hospital care. Though skills relating to problem-solving, decision-making, resource use and formation of patient-provider partnerships were evident among some participants, these required further development. Evidence of action planning or self-tailoring skills was sparse.
  
  
  CONCLUSIONS
  Education plays an important role in assisting individuals to self-manage their diabetes on a daily basis, but urgent, unexpected health problems proved challenging for both patients and health service providers. A greater focus on empowering patients with core self-management skills is required to enhance ability to successfully manage unexpected diabetes complications, coupled with enhanced primary care resources, particularly out-of-hours.
  
  
  CONCLUSIONS
  The importance of informal and structured diabetes education should not be underestimated; however, the challenge of improving skills such as problem-solving to manage urgent healthcare needs must be tackled. This study provokes debate regarding how best to deliver appropriate education and health services to cover urgent unscheduled care needs without automatically referring to emergency department hospital care.
authors.affiliation: Joint Appointment University of Ulster & Western Health and Social Care Trust, Institute of Nursing & Health Research, School of Nursing, University of Ulster, Coleraine, UK.
authors.forename: Vivien E
authors.initials: VE
authors.lastname: Coates
authors.affiliation: Bevital AS, Bergen, Norway.
authors.forename: Adrian
authors.initials: A
authors.lastname: McCann
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Natasha
authors.initials: N
authors.lastname: Posner
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gunn
authors.affiliation: RCN Research Institute, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Seers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000451:nursing / Q000523:psychology*; D004739:England; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012424:Rural Population; D013222:State Medicine; D014505:Urban Population; D055815:Young Adult
keywords: diabetes; health services; nursing; self-management skills; urgent care