Considering quality of care for young adults with diabetes in Ireland

Abstract

BackgroundResearch on the quality of diabetes care provided to young adults with Type 1 diabetes is lacking. This study investigates perceptions of quality of care for young adults with Type 1 diabetes (23–30 years old) living in the Republic of Ireland.MethodsThirty-five young adults with Type 1 diabetes (twenty-nine women, six men) and thirteen healthcare professionals (ten diabetes nurse specialists, three consultant Endocrinologists) were recruited. All study participants completed semi-structured interviews that explored their perspectives on the quality of diabetes services in Ireland. Interviews were analyzed using standard qualitative thematic analysis techniques.ResultsMost interviewees identified problems with Irish diabetes services for young adults. Healthcare services were often characterised by long waiting times, inadequate continuity of care, overreliance on junior doctors and inadequate professional-patient interaction times. Many rural and non-specialist services lacked funding for diabetes education programmes, diabetes nurse specialists, insulin pumps or for psychological support, though these services are important components of quality Type 1 diabetes healthcare. Allied health services such as psychology, podiatry and dietician services appeared to be underfunded in many parts of the country. While Irish diabetes services lacked funding prior to the recession, the economic decline in Ireland, and the subsequent austerity imposed on the Irish health service as a result of that decline, appears to have additional negative consequences. Despite these difficulties, a number of specialist healthcare services for young adults with diabetes seemed to be providing excellent quality of care. Although young adults and professionals identified many of the same problems with Irish diabetes services, professionals appeared to be more critical of diabetes services than young adults. Young adults generally expressed high levels of satisfaction with services, even where they noted that aspects of those services were sub-optimal.ConclusionGood quality care appears to be unequally distributed throughout Ireland. National austerity measures appear to be negatively impacting health services for young adults with diabetes. There is a need for more Endocrinologist and diabetes nurse specialist posts to be funded in Ireland, as well as allied health professional posts.

Living with type 1 diabetes as experienced by young adults

“…Studies (Bryden et al, ; Lin et al, ) indicated that young adult patients are especially vulnerable to psychological and psychiatric problems. Therefore, it is of great importance that young adults living with T1D are provided with continuous healthcare meetings, information, support and structured education (Balfe, Brugha, et al, ; MacDonald et al, ).…”

“…Longitudinal studies (Bryden, Dunger, Mayou, Peveler, & Neil, ; Vanstone, Rewegan, Brundisini, Dejean, & Giacomini, ) imply that up to 50 per cent of young adults with T1D develop diabetes‐related complications, these complications include retinopathy, neuropathy and hypertension. Studies (Balfe, Brugha, et al, ; Hanna, ; Hirjaba, Häggman‐Laitila, Peitilä, & Kangasniemi, ) show that young adults with T1D have an increased mortality risk compared with the population in general. Further, people diagnosed in early childhood, or those with a history of significant hypoglycemia or hyperglycaemia show increased risk for difficulties with working memory and attention (Lin, Northam, Rankins, Werther, & Cameron, ).…”

Type 1 Diabetes in Young Adulthood

“…If patients must move directly to the adult care system, use of a patient navigator or care coordinator may contribute to improved outcomes in adult care [52]. Some aspects of the adult medical care system may also hinder young adults’ participation, including difficulty accessing diabetes technology, lack of integrated diabetes services, long wait times for appointments, and brief or disjointed appointments with little continuity of care [53, 54]. …”

Type 1 diabetes: addressing the transition from pediatric to adult-oriented health care

“…Garvey et al 7 found that lack of a specific adult provider referral or contact information was the most frequently endorsed barrier to establishing adult care. Balfe et al 44,45 interviewed 35 young adults with diabetes aged 23–30 years about their experiences with diabetes management, including dealing with the health care system. Common complaints about the adult-oriented health care system included a lack of multidisciplinary diabetes care services, time constraints for routine appointments, difficulties with communication and continuity of care, and difficulty scheduling appointments.…”