Aim
To explore and analyse diabetes management challenges in the patients visiting a diabetes unit in Iran.
Background
Managing a chronic disease like diabetes needs the patients' follow‐up and coherent care delivery system. In fact, it requires a systematic and organised care delivery system with skilful and specialist team.
Methods
This qualitative research was conducted at a specialized poly‐clinic of Isfahan insurance organisation in 2016. The research participants were the members of clinic diabetes unit (physician, nurse, secretary, clinic director) and 21 type 2 diabetic patients of the clinic who were selected using purposeful sampling method. Data were collected by semi‐structured interviews and analysed using content analysis.
Results
The qualitative findings of this research were obtained in two main categories including the following: (a) weak care delivery system and (b) defective diabetes self‐care.
Conclusions
The results of this research have demonstrated that there are system‐centred and patient‐centred challenges in diabetes management, and they can affect the patients’ health outcomes.
Implications for nursing management
Since diabetes is one of the health system priorities, the findings of this study can be a warning for managers and policy makers to plan seriously to reform diabetes management system infrastructures.
Background:
Reforming the health care system to improve suitable health care model for diabetic patients is essential. This study aimed to implement, identify, and overcome the challenges of implementing the Chronic Care Model in diabetes management in a clinic.
Methods:
This study is a qualitative technical action research with the Kemmis and McTaggart model including planning, action, reflection, observation, and revision plan which was conducted in the specialized polyclinic from 2015 to 2017 in Isfahan city – Iran. Data were gathered through qualitative and quantitative methods. Diabetes team and 17 patients with type 2 diabetes participated in semi-structured interviews that were purposively chosen. Qualitative data were analyzed using content analysis and then quantitative data collected.
Results:
The qualitative findings of this research are in five main categories: System design upgrade, self-management upgrade, decision support, health care organization, and clinical information system upgrade. Results of quantitative data showed that most metabolic indicators like HbA1c have statistical meaningful changes (
P
value < 0.05).
Conclusions:
Implementing the Chronic Care Model became feasible despite serious challenges and two groups of ready and active team and active patients were developed. The study showed that one important lost link of diabetes management is underestimating the nurses’ capabilities in the management of this disease. Inevitably, serious investment on maximum use of nurses’ knowledge and skills in improving diabetes management will help diabetes care upgrade significantly.
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