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Aims and objectives To investigate factors influencing patients' self-management of urgent diabetes problems that precipitated unscheduled hospital care. Background Diabetes is placing increasing resource demands on health services and current policy advocates management in primary care and community settings whenever possible. Such policy has implications for patient education and empowerment and on mechanisms within primary and community care to support the management of diabetes when urgent healthcare problems arise. Design Qualitative, descriptive investigation, across two contrasting sites. Methods Forty-five people admitted to hospital for urgent/emergency care due to diabetes-related problems were recruited from urban and rural localities in the UK. Semi-structured interviews were conducted and data analysed using nvivo version 8 and framework techniques. Results Self-management of diabetes was typically habitual, and urgent problems that proved difficult to resolve necessitated recourse to unscheduled hospital care. Though skills relating to problem-solving, decision-making, resource use and formation of patient-provider partnerships were evident among some participants, these required further development. Evidence of action planning or self-tailoring skills was sparse. Conclusions Education plays an important role in assisting individuals to self-manage their diabetes on a daily basis, but urgent, unexpected health problems proved challenging for both patients and health service providers. A greater focus on empowering patients with core self-management skills is required to enhance ability to successfully manage unexpected diabetes complications, coupled with enhanced primary care resources, particularly out-of-hours. Relevance to clinical practice The importance of informal and structured diabetes education should not be underestimated; however, the challenge of improving skills such as problem-solving to manage urgent healthcare needs must be tackled. This study provokes debate regarding how best to deliver appropriate education and health services to cover urgent unscheduled care needs without automatically referring to emergency department hospital care. [ABSTRACT FROM AUTHOR]

The participation of service users in the planning and delivery of social work services has become a familiar objective in the UK. Policy injunctions, however, mask a lack of clarity around what is meant by terms such as ‘participation’ and ‘engagement’. Moreover, since many service users do not engage with social workers voluntarily, the expectation that they become centrally involved in the planning and delivery of services highlights tensions and contradictions. This article explores social work engagement with involuntary clients, drawing on findings from a knowledge exchange project involving academics and local authority social workers. A review of the literature traces the background to user involvement and identifies its different stages and types. Data from small-scale practitioner research projects undertaken within the project is then drawn on to illuminate how social workers and clients negotiate mutual engagement in their everyday encounters. It is suggested that the ‘roll out’ of the user engagement agenda may be understood as an exercise in the problematics of government. More optimistically, the work of Michel De Certeau is drawn on to propose that a practice of the everyday in such encounters rescues them from an ill-defined, abstract and undifferentiated policy agenda. [ABSTRACT FROM PUBLISHER]

Background: The incidence of gestational diabetes mellitus (GDM)--hyperglycemia with onset or first recognition during pregnancy--is increasing and will have a significant impact on diabetes services. This study aimed to determine the feasibility and acceptability of using telemedicine in the diabetes care of women with GDM and the possibility of replacing alternate (one in every two) diabetes review appointments with telemedicine.Subjects and Methods: A feasibility study for a randomized controlled trial was conducted across two sites. Fifty women with GDM were randomized to usual care (n = 26) or usual care plus telemedicine (n = 24). Telemedicine entailed weekly blood pressure and weight measurements and transmission of these data, along with blood glucose readings, for review by the healthcare team. Patients were contacted about these results as necessary. Patients completed questionnaires to measure their satisfaction with telemedicine or blood glucose monitoring. The intervention group and healthcare providers also took part in qualitative interviews. Analysis involved descriptive statistics for the satisfaction questionnaires and framework analysis for the qualitative interviews.Results: Eighty-nine percent of patients were satisfied with telemedicine and would use it again. Both HCPs and patients found the equipment easy to use and were positive about using it to replace alternate diabetes review appointments in the future. If used in this way, healthcare providers felt that protected time in which to perform the telemedicine review would be necessary.Conclusions: Telemedicine may help meet the growing demand on diabetes services due to increasing numbers of women being diagnosed with GDM. [ABSTRACT FROM AUTHOR]