Patient and Clinician Perceptions of Prediabetes: A Mixed-Methods Primary Care Study
Patient and Clinician Perceptions of Prediabetes: A Mixed-Methods Primary Care Study
复制标题
DOI：
10.1177/0145721719845347
复制
发表时间：
2019-06-01
影响因子：
3.9
通讯作者：
Keck, James
中科院分区：
文献类型：
--
作者：
Roper, Karen L.;Thomas, Alisha R.;Keck, James
目的：本研究的目的是评估患者和临床医生对糖尿病前期的看法，在学术家庭医学实践。收集数据是为了准备一项实施研究，以提高国家糖尿病预防计划（N-DPP）的利用率。方法采用混合研究方法，对3个糖尿病前期患者焦点小组的讨论进行主题分析，了解他们对糖尿病前期的理解和信念、护理经历和对N-DPP的态度。临床医生完成了一项Likert规模的调查，评估提供糖尿病前期护理的态度和感知障碍。结果在15名焦点小组参与者中，超过一半的人不知道他们的诊断。对前驱糖尿病的态度是混合的：虽然许多人认为这是严重的，并引起更多的恐惧，而不是“处于危险之中”，其他人认为在同一诊断中有不同程度的风险，使诊断的影响力较小。患者反复表达了临床医生对必要的行为改变不感兴趣的看法。患者同意N-DPP的障碍，包括时间安排和运输。临床医生（N = 31）一致认为，患者缺乏对糖尿病前期诊断的认识。他们报告说，有时间对所有患者进行筛查，糖尿病前期诊断对建议患者需要改变生活方式是有效的。患者和临床医生一致认为前驱糖尿病是可以治愈的。结论：需要提高患者意识和以患者为中心的教育，以克服糖尿病前期护理的障碍。为了促进N-DPP转诊流程的实施，临床医生应明确传达风险、治疗信息以及与N-DPP的联系，作为建议的治疗计划。
Purpose The purpose of the study was to assess patient and clinician perceptions of prediabetes in an academic family medicine practice. Data were collected in preparation for an implementation study to increase utilization of the National Diabetes Prevention Program (N-DPP). Methods In this mixed-methods study, discussions from 3 focus groups composed of patients with prediabetes were evaluated using thematic analysis for their understanding of and beliefs about prediabetes, care experiences, and attitudes toward N-DPP. Clinicians completed a Likert-scaled survey assessing attitudes and perceived barriers to providing prediabetes care. Results Among the 15 focus group participants, more than half were not aware of their diagnosis. Attitudes toward prediabetes were mixed: while many believed it was serious and elicited more fear than being "at risk," others thought there were varying degrees of risk within the same diagnosis, making the diagnosis less impactful. Patients repeatedly expressed the perception that clinicians were not forthcoming about necessary behavior changes. Patients agreed on barriers to N-DPP, including scheduling and transportation. Clinicians (N = 31) concurred that patients lack awareness of their prediabetes diagnosis. They reported that time is available to screen all patients and that a prediabetes diagnosis is effective for advising patients of the need for lifestyle modification. There was consensus from both patients and clinicians that prediabetes is curable. Conclusions Increased patient awareness and patient-centered education is needed to overcome barriers to prediabetes care. To facilitate implementation of N-DPP referral processes, clinicians should clearly communicate risk, treatment information, and linkage to N-DPP as the suggested treatment plan.