International challenges without borders: a descriptive study of family physicians' educational needs in the field of diabetes

Abstract

BackgroundThe optimal care of persons with diabetes by general practitioners and family physicians (GP/FP) is complex and requires multiple competencies. This is a fairly unrecognized key challenge in the healthcare systems. In some cases, local and national Continuous Professional Development (CPD) initiatives target these challenges; however there have been few international initiatives, possibly because challenges emerging from different studies have not been linked across national boundaries. In this context, the authors have compiled data about gaps and/or barriers inherent to GP/FP care of persons with type 2 diabetes from Austria, Canada, Germany and the United Kingdom.MethodsSecondary analyzes of pre-existing studies were conducted to identify challenges in the care of patients with type 2 diabetes as faced by GPs/FPs. Two sources of data were reviewed: unpublished research data from collaborating organizations and articles from a literature search (in English and German). Articles retrieved were scanned by the research team for relevance to the study objectives and to extract existing gaps and barriers. The identified challenges were then categorized along three major axes: (1) phase of the continuum of care {from screening to management}; (2) learning domain {knowledge, skills, attitudes, behavior, context}; and (3) by country/region. Compilation and categorization were performed by qualitative researchers and discrepancies were resolved through discussion until concordance was achieved.Results and discussionThirteen challenges faced by GPs/FPs in the care for patients with type 2 diabetes were common in at least 3 of the 4 targeted countries/regions. These issues were found across the entire continuum of care and included: pathophysiology of diabetes, diagnostic criteria, treatment targets assessment, drugs' modes of action, decision-making in therapies, treatment guidelines, insulin therapy, adherence, management of complications, lifestyle changes, team integration, bureaucracy and third-party payers. The issues reported were not restricted to the physicians' knowledge, but also related to their skills, attitudes, behaviours and context.ConclusionsThis study revealed challenges faced by GPs/FPs when caring for patients with diabetes, which were similar across international and health system borders. Common issues might be addressed more efficiently through international educational designs, adapted to each country's healthcare system, helping develop and maintain physicians' competencies.

Assessment of Knowledge, Attitude and Practices of Medical Officers in Primary Health Centres Regarding Type 2 Diabetes Mellitus

“…15 Many doctors in previous studies felt that use of insulin therapy is challenging. 10 Response was similar in the present study also. But substantial number of MOs felt comfortable with using the insulin.…”

“…There is evidence that even in developed countries HbA1c is being underutilized. 10 This study highlights the deficiencies in knowledge, attitude and practices of MOs towards management of T2DM. There is scope for improvement.…”

“…More than half (55) of the physicians prescribed appropriate medications for the treatment of T2DM. Insulin therapy was the most commonly (38) used mode of treatment, followed by sulfonylureas (34), metformin (27), and glitazones (10). The frequency of monitoring HbA1c levels varied from 3-6 months among 49 physicians.…”

“…However, previous studies in different countries have shown the lack of utilization of these developments by primary care physicians. [9][10][11] The present study aimed to evaluate the knowledge, attitude, and practice of MOs in rural PHCs regarding T2DM. Many of the MOs were not aware of the epidemiological and etiological burden in the management of T2DM.…”

The effect of a patient-oriented treatment decision aid for risk factor management in patients with diabetes (PORTDA-diab): study protocol for a randomised controlled trial

“…Time constraints, lack of support, patients’ motivation and treatment compliance, as well as discrepancies between provider and patient perceptions have been identified as reasons for not providing optimal care in diabetes [10,12,13]. Healthcare providers perceive risk communication as difficult and time-consuming, and want additional tools to help them improve their patients’ understanding of risks [9,14-16].…”