Seeking Care for Hyperglycemia in the Emergency Department: Through the Eyes of the Patient.

Health care systems often provide a range of options of care for patients with illnesses who do not require hospital admission. For individuals with diabetes, these options may include primary care providers, specialized diabetes clinics, and urgent care and walk-in clinics. We explored the reasons why patients choose the Emergency Department over other health care settings when seeking care for hyperglycemia.

A survey of one CCFP-EM program's graduates: their background, intended type of practice and actual practice.

OBJECTIVES: Our primary objective was to survey the graduates of one residency program with respect to anticipated versus actual medical practice. METHODS: Using a modified Dillman technique, we surveyed all 83 physicians who had completed one year of residency training that led to certification of special competency in Emergency Medicine (CCFP-EM) at the University of Western Ontario (UWO) from 1982-2004. Respondents were asked what type of medicine they had thought they would practise before beginning their emergency medicine training. They were then asked to describe their employment from graduation to present time. Additional demographic information was collected. Correlation between demographic factors and other selected factors of influence upon career decisions was analyzed. RESULTS: Our response rate was 87% (72/83), with 71% (51/72) respondents being male. At the start of their CCFP-EM residency training, 50% of respondents intended to practise emergency medicine exclusively and 47% intended to blend family and emergency medicine. For each of the respondents' first 4 positions of employment, the greatest percentage were practising emergency medicine only (ranging from 72% in position 1 to 53% in position 4), while the number engaging in a blended family/emergency medicine practice never exceeded 20%. No demographic factors surveyed had significant correlation with intended or actual practice. In all positions of employment, "type of practice" was ranked as the most influential factor in choosing that position. CONCLUSION: Most graduates of the UWO CCFP-EM program practise in emergency medicine only positions. Less than 20% are engaged in a blended family/emergency medicine practice. At training onset, one-half of the residents intended to practise emergency medicine exclusively. None of the demographic factors surveyed significantly correlated with intended or actual practice. Further examination of the practice patterns of all emergency medicine residency program graduates is an essential part of future planning for the specialty of Emergency Medicine in Canada.