A qualitative study to explore experiences and views of patients and their family members managing steroid-induced hyperglycaemia (SIH) out of hospital

Abstract

Aim

To explore the experiences of patients, families and clinicians managing steroid-induced hyperglycaemia (SIH) out of the hospital and identify areas for improved care.

Methods

We searched hospital records to identify patients requiring input from the diabetes inpatient team between February 2022 and March 2023 due to steroid usage. Clinicians, patients and their family members were interviewed remotely about their experiences of care and views on how to improve it. Patient characteristics were extracted from hospital records and descriptively summarised. Interview data were subjected to framework analysis.

Results

We interviewed 23 patients (60% male, aged 40–88 years). The median (IQR) glucocorticoid daily dose (prednisolone-equivalent) was 40 mg (20–60). Fifteen (65%) patients were followed up after discharge by the diabetes specialist team, the remainder being referred to primary care. Nine family members and five diabetes care clinicians were also interviewed.

SIH impacts negatively on patients' and families' physical and social well-being and increases clinical workload. Participants reported feeling anxious and uncertain when self managing SIH out of hospital, particularly those with multimorbidity and no prior history of diabetes. Regular post-discharge clinical follow-up builds patients' confidence and satisfaction, but there was limited post-discharge follow-up care, and conflicting advice was provided on SIH management from different care teams. Better discharge care planning, communication, family support and provision of SIH self management resources could improve care and experiences.

Conclusion

Our findings emphasise having robust, individualised, post-discharge care planning; better communication across care pathways; and provision of skills and resources to all partners in healthcare.