Abstract
BackgroundAn exploration of renal complications of diabetes from the patient perspective is important for developing quality care through the diabetic renal disease care pathway.MethodsNewly referred South Asian and White diabetic renal patients over 16 years were recruited from nephrology outpatient clinics in three UK centres - Luton, West London and Leicester – and their experiences of the diabetes and renal care recorded.A semi-structured qualitative interview was conducted with 48 patients. Interview transcripts were analysed thematically and comparisons made between the White and South Asian groups.Results23 South Asian patients and 25 White patients were interviewed. Patient experience of diabetes ranged from a few months to 35 years with a mean time since diagnosis of 12.1 years and 17.1 years for the South Asian and White patients respectively. Confusion emerged as a response to referral shared by both groups. This sense of confusion was associated with reported lack of information at the time of referral, but also before referral. Language barriers exacerbated confusion for South Asian patients.ConclusionsThe diabetic renal patients who have been referred for specialist renal care and found the referral process confusing have poor of awareness of kidney complications of diabetes. Healthcare providers should be more aware of the ongoing information needs of long term diabetics as well as the context of any information exchange including language barriers.
Highlights
An exploration of renal complications of diabetes from the patient perspective is important for developing quality care through the diabetic renal disease care pathway
Previous studies in the UK have identified a greater relative risk for type 2 diabetes related end-stage renal disease (ESRD) in South Asians [1,2], and preliminary evidence has suggested that quality of health care for South Asians is inadequate and compliance poor [3,4]
The results identify themes that relate to access on an individual level – reaction to referral; understanding at referral; understanding prior to referral; influence of comorbidities and influence of ethnicity – which provide a picture of patient experience of the diabetic renal disease care pathway at referral for these two groups
Summary
An exploration of renal complications of diabetes from the patient perspective is important for developing quality care through the diabetic renal disease care pathway. National Service Frameworks for Diabetes and Renal Services were introduced in the UK in 2002 and 2006 respectively. These Frameworks provide guidance to commissioners and providers of health care commissioners about the minimum standards of care that should be offered across the UK. The Frameworks recognised the disparity between ethnic groups and promoted a focus on earlier detection and ethnicity as a risk factor to improve outcomes for diabetic renal disease across different population groups [7,8]. The introduction of the Quality Outcomes Framework indicators in primary care for diabetes in 2004 and estimated glomerular filtration rate (eGFR) reporting in 2007 were both infrastructure developments introduced to improve for quality of care for all diabetes patients [9,10,11]
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