title: "I wish they could be in my shoes": patients' insights into tertiary health care for type 2 diabetes mellitus.
abstract: BACKGROUND
  Insightful accounts of patient experience within a health care system can be valuable for facilitating improvements in service delivery.
  
  
  OBJECTIVE
  The aim of this study was to explore patients' perceptions and experiences regarding a tertiary hospital Diabetes and Endocrinology outpatient service for the management of type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  Nine patients participated in discovery interviews with an independent trained facilitator. Patients' stories were synthesized thematically using a constant comparative approach.
  
  
  RESULTS
  Three major themes were identified from the patients' stories: 1) understanding T2DM and diabetes management with subthemes highlighting that specialist care is highly valued by patients who experience a significant burden of diabetes on daily life and who may have low health literacy and low self confidence; 2) relationships with practitioners were viewed critical and perceived lack of empathy impacted the effectiveness of care; and 3) impact of health care systems on service delivery with lack of continuity of care relating to the tertiary hospital model and limitations with appointment bookings negatively impacting on patient experience.
  
  
  CONCLUSIONS
  The patients' stories suggest that the expectation of establishing a productive, ongoing relationship with practitioners is highly valued. Tertiary clinics for T2DM are well placed to incorporate novel technological approaches for monitoring and follow-up, which may overcome many of the perceived barriers of traditional service delivery.
  
  
  CONCLUSIONS
  Investing in strategies that promote patient-practitioner relationships may enhance effectiveness of treatment for T2DM by meeting patient expectations of personalized care. Future changes in service delivery would benefit from incorporating patients as key stakeholders in service evaluation.
authors.affiliation: Department of Nutrition and Dietetics, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Jacqueline D
authors.initials: JD
authors.lastname: Cotugno
authors.affiliation: Department of Nutrition and Dietetics, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia ; School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Maree
authors.initials: M
authors.lastname: Ferguson
authors.affiliation: INNIS Partnership, Brisbane, QLD, Australia.
authors.forename: Hazel
authors.initials: H
authors.lastname: Harden
authors.affiliation: INNIS Partnership, Brisbane, QLD, Australia.
authors.forename: Shoni
authors.initials: S
authors.lastname: Colquist
authors.affiliation: Department of Nutrition and Dietetics, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Annabelle A
authors.initials: AA
authors.lastname: Stack
authors.affiliation: Department of Diabetes & Endocrinology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Jane I
authors.initials: JI
authors.lastname: Zimmerman
authors.affiliation: Department of Diabetes & Endocrinology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia ; School of Medicine, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Russell
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Ball
authors.affiliation: Department of Nutrition and Dietetics, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia ; The Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Ingrid J
authors.initials: IJ
authors.lastname: Hickman
keywords: diabetes mellitus; discovery interview; health care; personal narratives