Table 2 Coded categories and themes
Perceived barriers to optimal diabetes care | ||
|---|---|---|
Level | Factor | Item |
Physician | Lack of knowledge on | - global cardiovascular treatment beyond glycemic control - insulin therapy |
| Â | Lack of awareness regarding | - personal practice performance ('blind spots') - need to reach treatment targets and regular follow-up |
| Â | 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 |
| Â | Lack of knowledge on | - insight regarding complications, significance of HbA1c |
| Â | Lack of awareness regarding | - personal dietary patterns - personal health status (HbA1c, blood pressure, cholesterol) |
| Â | Attitude and motivation | - fear of insulin treatment - lack of motivation for follow-up or to change lifestyle |
| Â | 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 |
| Â | Relationships | - between GPs and patients (inertia to change) - competition between specialists and GPs |
| Â | 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 |
| Â | 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 | Â | Item |
Physician | Â | 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 | Â | 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 | |