Applying the Three Delay Model for Non-communicable diseases: lessons learnt from emergency department admissions in Peru

In many low- and middle-income countries, people with diabetes and hypertension lack timely, quality healthcare and often turn to overcrowded emergency departments (ED). This study explored experiences and barriers to care among adults with type 2 diabetes mellitus (T2DM) or hypertension (HT) admitted to a public emergency department. We conducted a hospital-based study including questionnaires, 3-month follow-up calls, and semi-structured interviews. Questionnaires collected sociodemographic characteristics, medical history, medication, hospitalization details, and discharge indications. Interviews, analyzed through the Three Delays framework, explored prior healthcare experiences, disease knowledge and perception, and care facilitators and barriers. A total of 189 adults with T2DM and/or HT were surveyed; mean age was 60.8 (SD 13.7), with 50.3% male. Of these, 62.4% did not seek care periodically and 33.7% missed follow-up appointments. Twenty interviews revealed recurring delays due to previous negative experiences, poor disease awareness, excessive costs, time and transportation constraints, and insufficient supplies. People with chronic conditions face repeated delays and difficulties navigating the health system, often reaching care only in emergency situations. These findings call for targeted interventions to improve lower levels of care to break these cycles, reduce ED burden, improve continuity and ensure sustainable management of chronic conditions.