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Table 2 Coded categories and themes

From: Barriers and facilitators to evidence based care of type 2 diabetes patients: experiences of general practitioners participating to a quality improvement program

Perceived barriers to optimal diabetes care
Level Factor Item
Physician Lack of knowledge on - global cardiovascular treatment beyond glycemic control
- insulin therapy
  Lack of awareness regarding - personal practice performance ('blind spots')
- need to reach treatment targets and regular follow-up
  Attitude and motivation - laxity regarding treatment targets and timely follow-up
- attitude to polypharmacy
- skepticism regarding evidence-based treatment, top-down quality improvement projects and shared care collaboration
Patient Practice organization - lack of scheduled visits, lack of planned follow-up, lack of support staff
  Lack of knowledge on - insight regarding complications, significance of HbA1c
  Lack of awareness regarding - personal dietary patterns
- personal health status (HbA1c, blood pressure, cholesterol)
  Attitude and motivation - fear of insulin treatment
- lack of motivation for follow-up or to change lifestyle
  Routine behavior - maintaining lifestyle change very difficult
- adhering to planned follow-up visits is difficult
Context and organization Age and co-morbidity - too strict control can be dangerous in older patients
- immobility hampers physical exercise and shared care referral
  Relationships - between GPs and patients (inertia to change)
- competition between specialists and GPs
  Lack of teamwork - Need for clear description of each provider's duties and responsibilities
- Need for identical messages to the patients from all health care providers
  Financial barriers - out-of-pocket payments for education, dietary advice and HBGM material
- skewed reimbursement of HBGM material
- fee for service: this system doesn't motivate GPs to deliver high-quality care
Perceived change facilitators
Level of impact   Item
Physician   Treatment protocol and post-graduate education; Benchmarking feedback
Case coaching; Timely data collection
Increased contact and communication with peers in other disciplines
Participation in team meetings
Attitude change on the part of specialists
Patient   Nurse educator and IDCT working as a team
Free services and free materials
Identical messages from different sources (GP, specialist, educator, television
Attitude change on the part of the GP
Context and organization Role redesign and reassignment of responsibilities
Serial removal of barriers
Task relief
  1. HBGM = Home Blood Glucose Monitoring; IDCT = Interdisciplinary Diabetes Care Team (endocrinologist, nurse educator, dietician) installed at the primary care level