Discordance in Perceptions of Barriers to Diabetes Care Between Patients and Primary Care and Secondary Care

Abstract

OBJECTIVE -We sought to compare perceived barriers to diabetes care between people with diabetes and different health professional groups. RESULTS -Barriers were reported in 69.7% of patients. Psychological barriers were most important (55.5%), followed by systems barriers (25.7%), and then knowledge as least important (15.3%). Psychological barriers were ranked first among general practitioners (91.0%), but systems barriers were ranked first by other health professionals (38.8 -100%). General practitioner and patient barrier group rankings were similar (r T ϭ 0.976, P Ͻ 0.05). Of specific barriers among individuals with diabetes, strictness of treatment regimen was the most frequently reported (42.3 vs. 0.1-16.8%) (P Ͻ 0.001) and 2.5 (95% CI 2.4 -2.7)-to 3.4 (3.2-3.7)-fold more than the 2nd through 4th ranked barriers. Motivation was the most common specific barrier reported by general practitioners (86%), practice nurses (31.5%), and the diabetes team (85.7%). Practice and hospital nurse/dietitian rankings were most comparable with patients (r T ϭ 0.457 and 0.466, respectively, both P Ͻ 0.05). A major area of patient-health professional discordance was the influence of other health problems, which was ranked 2nd among patients but 10th-18th among health professionals. RESEARCH DESIGN AND METHODSCONCLUSIONS -The most important barriers to diabetes care perceived by patients are psychological and particularly relate to the strictness of the regimen. Discordance between patients and different health professionals exists in the perception of the importance of different barriers to diabetes care. Diabetes Care 30:490 -495, 2007

Low attendance at structured education for people with newly diagnosed type 2 diabetes: General practice characteristics and individual patient factors predict uptake

“…On a positive note we did not find an association between ethnicity and attendance at structured education, found in one US study [12], although we did broadly group participants into ethnic groups and qualitative research has demonstrated that some West Africans might be opposed to group education for fear of stigmatisation [18]. Overall, the findings contrast with patient-reported barriers to diabetes self-management, which have identified psychological and psychosocial barriers [13]. We found no association between selfreported depression, diabetes-related distress, or diabetes self-efficacy with attendance at structured education and there is no suggestion as to what the underlying mechanisms are which motivate people to attend.…”

“…Well known barriers to optimal diabetes self-care include psychological and social factors [13] and low levels of health literacy may discourage attendance or prevent those affected from benefitting from this mode of self-management support [14][15][16][17]. Qualitative research of patient barriers to attending structured education programmes have identified: lack of information regarding DSME from health professionals, not perceiving the benefit of attendance, difficulties in access, and shame and stigma of diabetes [18].…”

“Damm Sokkor”: Factors Associated With the Quality of Care of Patients With Diabetes

“…Historically, more emphasis has been placed on the training and education of clinicians rather than their attitudes and beliefs, but motivation of the health professionals is increasingly being recognized as having as central role in diabetes care (12). However, this finding must be approached with caution given the subjective nature of the term "motivation," even within the context of a theoretical model (30), and the subjective method of data collection (interviews and observations).…”

“…Commonly reported patient factors are adherence, attendance, and education together with individual characteristics such as age, sex, and presence of comorbidity (11)(12)(13)(14). Health physician factors include the number, training, and sex of the treating physician and practice team; the role of clinical inertia; and the clinician/ patient relationship (10,12,(15)(16)(17)(18). Many organizational factors have been shown to influence care such as the use of structured diabetes clinics, recall systems, practice guidelines, and educational programs (14,19).…”

Effective Intervention of Self-Care on Glycaemia Control in Patients With Type 2 Diabetes

“…Although the prevention of morbidity and mortality of these cases seems simple, many patients with diabetes do not follow their physician’s self-care recommendations regarding diabetes. Although Iranian patients have little information about the average blood sugar control, the increasing diabetes prevalence is an alarm of the poor diabetes control among them (9, 10). Self-care improves the quality of life and also may reduce costs.…”