title: Contested Ownership of Disease and Ambulatory-Sensitive Emergency Department Visits for Type 2 Diabetes.
abstract: BACKGROUND
  Approximately 21 million persons have diabetes and account for 11.9% of all emergency department (ED) visits for a total cost of $14.1 billion. Nonemergent visits for ambulatory-sensitive conditions that could be managed by the primary care provider make up almost one-third of the ED visits. African Americans comprise approximately 30% of South Carolina's population but make up approximately 50% of the ED visits for diabetes. The purpose of the research was to explore the experiences of 20 African-American adults with diabetes with ambulatory-sensitive ED use.
  
  
  METHODS
  The research design for this study is grounded theory with dimensional analysis methods. Following ethics approval and informed consent, interviews were conducted, recorded and transcribed verbatim, and themes were analyzed to form the explanatory framework or matrix for ED use. The framework of context, conditions, processes and consequences provides a key for understanding the themes of the story embedded in the descriptive narratives.
  
  
  RESULTS
  The contested ownership of diabetes was the overarching perspective--"doing what I got to do," "it's always on mind… wishing not to be a diabetic" and "it's a constant burden." And handling diabetes involved taking decisions "into your hands." The context of perceived urgency of symptoms included all the reasons that precipitated ED visit--personal experience, primary care access and services and social network support for decisions--influenced ownership of these decisions.
authors.affiliation: College of Nursing, Charleston Southern University, Charleston, South Carolina.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Shearer
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, South Carolina. Electronic address: Jenkins@musc.edu.
authors.forename: Carolyn H
authors.initials: CH
authors.lastname: Jenkins
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Gayenell S
authors.initials: GS
authors.lastname: Magwood
authors.affiliation: College of Nursing, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson VA Medical Center, Charleston, South Carolina.
authors.forename: Charlene A
authors.initials: CA
authors.lastname: Pope
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D066296:Grounded Theory; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires
keywords: Ambulatory-sensitive conditions; Emergency department use; Grounded theory with dimensional analysis; Qualitative research; Type 2 diabetes