Aims: Hypoglycaemia is a common treatment consequence in diabetes mellitus. Prior studies have shown that a large proportion of people with paramedic assist-requiring hypoglycaemia prefer not to be transported to hospital. Thus, these episodes are "invisible" to their usual diabetes care providers. A direct electronic referral programme where paramedics sent referrals focused hypoglycaemia education at the time of paramedic assessment was implemented in our region for 18 months; however, referral programme uptake was low. In this study, we examined patient and paramedic experiences with a direct electronic referral programme for hypoglycaemia education postparamedic assist-requiring hypoglycaemia, including barriers to programme referral and education attendance. Methods: We surveyed paramedics and conducted semistructured telephone interviews of patients with paramedic-assisted hypoglycaemia who consented to the referral programme and were scheduled for an education session in London and Middlesex County, Canada. Results: Paramedics and patient participants felt that the direct referral programme was beneficial. A third of paramedics who responded to our survey used the referral programme for each encounter where they treated patients for hypoglycaemia.Patients felt very positive about the referral programme and their paramedic encounter; however, they described embarrassment, guilt and prior negative experience as key barriers to attending education. Conclusions: Paramedics and patients felt that direct referral for focused hypoglycaemia education postparamedic assist-requiring hypoglycaemia was an excellent strategy. Despite this, referral programme participation was low and thus there remain ongoing barriers to implementation and attendance. Future iterations should consider how best to meet patient needs through innovative delivery methods. K E Y W O R D Sdiabetes mellitus, emergency medical technicians, health education, hypoglycaemia, qualitative research 2 of 10 | LIU et aL.
There is tremendous attention in maternal and neonatal disparities, particularly disparities of race and ethnicity and subsequent outcomes that continue despite calls to action. The literature has offered potential opportunities for exploring data related to racial and ethnic disparities, including the utilization of a race and ethnicity reporting dashboard. This article reviews definitions of perinatal quality and disparity and provides insight into the development of a nationally targeted race and ethnicity dashboard. This quarterly dashboard provides hospitals with specific key metric outcomes through the lens of race and ethnicity, provides a national benchmark for comparison, and creates a data platform for team exploration and comprehensive review of findings. An overview of the development of the dashboard is provided, and the selection of key maternal and neonatal metrics is reviewed. In addition, recommendations for data science strategic planning and nursing's role in metric development, analysis, and utilization are offered and key steps in accelerating disparity data into everyday clinical care are discussed.
Hypoglycemia requiring paramedic assistance negatively impacts outcomes in people with diabetes. Prior studies have shown only a small proportion of those with paramedic assist-requiring HG are brought to hospital. These episodes are thus “invisible” to the health care system. An innovative direct electronic referral program in which paramedics sent a referral for focused HG education to the Diabetes Education Centre (DEC) at the time of paramedic assessment was implemented for 18 months. Program uptake was lower than expected (133 referrals, 79 scheduled, and 50 attended). This qualitative study examines barriers and facilitators of DEC attendance for HG education after paramedic assist-requiring HG. We conducted semi-structured interviews of patients with paramedic-assisted HG and surveyed paramedics about their experiences. Of 34 paramedics, 30 (88%) attended at least 1 HG call in the study period and 26 (76%) used the referral program. Fourteen patients (18% response rate) participated: 8 men (57%); 13 (93%) age ≥ 50 yrs. Eight patients (57%) recalled the paramedic referral, 6 (43%) did not, and 4 (29%) thought they were referred by their family doctor. One patient thought attendance was mandatory to keep their drivers’ license. Themes identified from patient responses included: positive impact of diabetes education especially if delivered early after diagnosis, importance of spousal support and in-person education. Barriers to attendance were prior DEC attendance especially in those with long diabetes duration and embarrassment (failure to self-manage, memory loss around the HG event). While patients felt that focused HG education is an excellent strategy to reduce recurrent episodes, many had already attended similar sessions and felt further education was not needed. Hence, an important gap in providing HG education to patients with severe HG may be both system-based and disease-related. Disclosure S.L. Liu: Consultant; Self; Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; Novo Nordisk Inc., Sanofi. A. Rosa: None. S.L. Sibbald: None. J. Mahon: None. D.R. Carter: None. M. Peddle: None. T. Spaic: Research Support; Self; Novo Nordisk Inc. Speaker’s Bureau; Self; Dexcom, Inc., Sanofi. Funding Academic Medical Association of Southwestern Ontario (INN16-004)
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