Display options
Cite
Liu SL, Sibbald SL, Rosa A, et al. Patient and paramedic experiences with a direct electronic referral programme for focused hypoglycaemia education following paramedic service assist-requiring hypoglycaemia in London and Middlesex County, Ontario, Canada. Diabet Med. 2021;38(8):e14569doi: 10.1111/dme.14569.
Liu, S. L., Sibbald, S. L., Rosa, A., Mahon, J. L., Carter, D. R., Peddle, M., & Spaic, T. (2021). Patient and paramedic experiences with a direct electronic referral programme for focused hypoglycaemia education following paramedic service assist-requiring hypoglycaemia in London and Middlesex County, Ontario, Canada. Diabetic medicine : a journal of the British Diabetic Association, 38(8), e14569. https://doi.org/10.1111/dme.14569
Liu, Selina L, et al. "Patient and paramedic experiences with a direct electronic referral programme for focused hypoglycaemia education following paramedic service assist-requiring hypoglycaemia in London and Middlesex County, Ontario, Canada." Diabetic medicine : a journal of the British Diabetic Association vol. 38,8 (2021): e14569. doi: https://doi.org/10.1111/dme.14569
Liu SL, Sibbald SL, Rosa A, Mahon JL, Carter DR, Peddle M, Spaic T. Patient and paramedic experiences with a direct electronic referral programme for focused hypoglycaemia education following paramedic service assist-requiring hypoglycaemia in London and Middlesex County, Ontario, Canada. Diabet Med. 2021 Aug;38(8):e14569. doi: 10.1111/dme.14569. Epub 2021 Apr 09. PMID: 33774853.
Copy Download .nbib Format: NLM
Share it on

Diabet Med. 2021 Aug;38(8):e14569. doi: 10.1111/dme.14569. Epub 2021 Apr 09.

Patient and paramedic experiences with a direct electronic referral programme for focused hypoglycaemia education following paramedic service assist-requiring hypoglycaemia in London and Middlesex County, Ontario, Canada.

Diabetic medicine : a journal of the British Diabetic Association

Selina L Liu, Shannon L Sibbald, Andrew Rosa, Jeffrey L Mahon, Dustin R Carter, Michael Peddle, Tamara Spaic

Affiliations

  1. Division of Endocrinology and Metabolism, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
  2. St. Joseph's Health Care London, London, ON, Canada.
  3. School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada.
  4. Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
  5. The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
  6. Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
  7. Middlesex-London Paramedic Service, London, ON, Canada.
  8. Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.

PMID: 33774853 DOI: 10.1111/dme.14569

Abstract

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.

© 2021 Diabetes UK.

Keywords: diabetes mellitus; emergency medical technicians; health education; hypoglycaemia; qualitative research

References

  1. Aronson R, Goldenberg R, Boras D, Skovgaard R, Bajaj H. The Canadian Hypoglycemia Assessment Tool Program: insights into rates and implications of hypoglycemia from an observational study. Can J Diab. 2017. pii: S1499-2671(16)30781-X. - PubMed
  2. Pedersen-Bjergaard U, Thorsteinsson B. Reporting severe hypoglycemia in type 1 diabetes: facts and pitfalls. Curr Diab Rep. 2017;17(12):131. - PubMed
  3. Edridge CL, Dunkley AJ, Bodicoat DH, et al. Prevalence and incidence of hypoglycaemia in 532,542 people with type 2 diabetes on oral therapies and insulin: a systematic review and meta-analysis of population based studies. PLoS One. 2015;10(6):e0126427. - PubMed
  4. Donnelly LA, Morris AD, Frier BM, et al. Frequency and predictors of hypoglycaemia in type 1 and insulin-treated type 2 diabetes: a population-based study. Diabet Med. 2005;22(6):749-755. - PubMed
  5. UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. 2007;50(6):1140-1147. - PubMed
  6. Simon D, de Pablos-Velasco P, Parhofer KG, et al. Hypoglycaemic episodes in patients with type 2 diabetes-risk factors and associations with patient-reported outcomes: the PANORAMA Study. Diabetes Metab. 2015;41(6):470-479. - PubMed
  7. Davis SN, Duckworth W, Emanuele N, et al. Effects of severe hypoglycemia on cardiovascular outcomes and death in the Veterans Affairs Diabetes Trial. Diabetes Care. 2019;42(10):157-163. - PubMed
  8. Zoungas S, Patel A, Chalmers J, et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med. 2010;363(15):1410-1418. - PubMed
  9. Wild D, von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L. A critical review of the literature on fear of hypoglycemia in diabetes: implications for diabetes management and patient education. Patient Educ Couns. 2007;68(1):10-15. - PubMed
  10. Farmer AJ, Brockbank KJ, Keech ML, England EJ, Deakin CD. Incidence and costs of severe hypoglycaemia requiring attendance by the emergency medical services in South Central England. Diabet Med. 2012;29(11):1447-1450. - PubMed
  11. Sampson M, Bailey M, Clark J, et al. A new integrated care pathway for ambulance attended severe hypoglycaemia in the East of England: the Eastern Academic Health Science Network (EAHSN) model. Diabetes Res Clin Pract. 2017;133:50-59. - PubMed
  12. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2013;37(Suppl 1):S1-S212. - PubMed
  13. LaManna J, Litchman ML, Dickinson JK, et al. Diabetes education impact on hypoglycemia outcomes: a systematic review of evidence and gaps in the literature. Diabetes Educ. 2019;45(3):349-369. - PubMed
  14. Iqbal A, Heller SR. The role of structured education in the management of hypoglycaemia. Diabetologia. 2018;61(4):751-760. - PubMed
  15. Temple B, Epp D. Evaluation of a diabetes education program's non-attendees: the program response. Can J Diabetes. 2009;33(4):375-380. - PubMed
  16. Schäfer I, Pawels M, Küver C, et al. Strategies for improving participation in diabetes education. A qualitative study. PLoS One. 2014;9(4):e95035. - PubMed
  17. Östenson CG, Geelhoed-Duijvestijn P, Lahtela J, Weitgasser R, Markert Jensen M, Pedersen-Bjergaard U. Self-reported non-severe hypoglycaemic events in Europe. Diabet Med. 2014;31(1):92-101. - PubMed
  18. Mojdami D, Mitchell BD, Spaepen E, et al. Conversations and reactions around severe hypoglycemia study: results of Canadian adults with insulin treated diabetes and caregivers. Can J Diabetes. 2020;S1499-2671(20):30348-8. https://doi.org/10.1016/j.jcjd.2020.08.104 - PubMed
  19. Statistics Canada. 2017. Middlesex, CTY [Census division], Ontario and Ontario [Province] (table). Census Profile. 2016 Census. Statistics Canada Catalogue no. 98-316-X2016001. Ottawa. Released November 29, 2017. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/prof/index.cfm?Lang=E. Accessed August 3, 2020. - PubMed
  20. Duncan EAS, Fitzpatrick D, Ikegwuonu T, Evans J, Maxwell M. Role and prevalence of impaired awareness of hypoglycemia in ambulance service attendances to people who have had a severe hypoglycaemic emergency: a mixed-methods study. BMJ Open. 2018;8(4):e019522. - PubMed
  21. Duncan EA, Fitzpatrick D. Improving self-referral for diabetes care following hypoglycaemic emergencies: a feasibility study with linked patient data analysis. BMC Emerg Med. 2016;18(16):13. - PubMed
  22. Brydges M, Spearen C, Birze A, Tavares W. A culture in transition: paramedic experiences with community referral programs. CJEM. 2015;17(6):631-638. - PubMed
  23. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. - PubMed
  24. Guest G, MacQueen KM, Namey EE. Applied thematic analysis. Thousand Oaks, CA: SAGE Publications Inc.; 2012. - PubMed
  25. Lincoln YS, Guba EG. Naturalistic inquiry. Newbury Park, CA: SAGE Publications Inc.; 1995. - PubMed
  26. Walker A, James C, Bannister M, Jobes E. Evaluation of a diabetes referral pathway for the management of hypoglycaemia following emergency contact with the ambulance service to a diabetes specialist nurse team. Emerg Med J. 2006;23(6):449-451. - PubMed
  27. Liu NF, Brown AS, Folias AE, et al. Stigma in people with type 1 or type 2 diabetes. Clin Diabetes. 2017;35:27-34. - PubMed
  28. Brazeau AS, Nakhla M, Wright M, et al. Stigma and its association with glycemic control and hypoglycemia in adolescents and young adults with type 1 diabetes: cross-sectional study. J Med Internet Res. 2018;20:e151. - PubMed
  29. Mc Sharry J, Dinneen SF, Humphreys M, et al. Barriers and facilitators to attendance at type 2 diabetes structured education programmes: a qualitative study of educators and attendees. Diabet Med. 2019;36(1):70-79. - PubMed
  30. Horigan G, Davies M, Findlay-White F, Chaney D, Coates V. Reasons why patients referred to diabetes education programmes choose not to attend: a systematic review. Diabet Med. 2017;34(1):14-26. - PubMed

Publication Types

Grant support