Primary care management of diabetes in a low/middle income country: A multi-method, qualitative study of barriers and facilitators to care
Primary care management of diabetes in a low/middle income country: A multi-method, qualitative study of barriers and facilitators to care
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DOI：
10.1186/1471-2296-8-63
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发表时间：
2007-11-09
影响因子：
2.9
通讯作者：
Nabli, Mounira
中科院分区：
文献类型：
--
作者：
Alberti, Hugh;Boudriga, Nessiba;Nabli, Mounira
背景：糖尿病患者的管理是复杂的。发达国家已经进行了一些研究，试图确定影响糖尿病患者护理质量的因素：迄今假定的因素通常分为患者、临床医生和组织因素。我们的研究试图找出在低/中等收入国家初级保健中管理糖尿病的主要障碍和促进者。方法：定性研究，基于参与者观察的反身性民族志，对临床医生的半结构化访谈(10)，以及对三个有目的地抽样的卫生中心的辅助医疗工作人员(4)和患者(12)的小组访谈，以及在突尼斯全国50多个其他卫生中心的非正式观察和讨论。对数据进行了内容分析。结果：在突尼斯，出现了400多个在初级保健中护理糖尿病患者的潜在障碍或促进者。总体而言，最常见的被引用因素是医疗中心的药物供应。其他经常观察到的组织因素是慢性病诊所的存在和临床医生的工作量。最常被提及的健康职业因素是医生的积极性。经常提到的患者因素是财务问题、患者教育以及遵从性和出诊问题。研究人员、医生、辅助医务人员和患者对各种因素的重视程度存在显著差异。结论：我们发现了大量潜在的护理障碍和促进者，这些障碍和促进者可能会潜在地影响突尼斯这个中低收入国家的初级保健中糖尿病患者的护理。认识和了解这些因素对于制定文化上适当的干预措施以改善对糖尿病患者的护理是至关重要的。
Background: The management of patients with diabetes mellitus is complex. Some research has been done in developed countries to attempt to determine the factors that influence quality of care of patients with diabetes: Factors thus far postulated are usually categorised into patient, clinician and organisational factors. Our study sought to discover the main barriers and facilitators to care in the management of diabetes in primary care in a low/ middle income country.Methods: A qualitative study, based on reflexive ethnography using participant observation, semi-structured interviews of clinicians (10) and group interviews with paramedical staff (4) and patients (12) in three purposively sampled health centres, along with informal observation and discussions at over 50 other health centres throughout Tunisia. A content analysis of the data was performed.Results: Over 400 potential barriers or facilitators to care of patients with diabetes in primary care in Tunisia emerged. Overall, the most common cited factor was the availability of medication at the health centre. Other frequently observed organisational factors were the existence of chronic disease clinics and clinicians workload. The most commonly mentioned health professional factor was doctor motivation. Frequently cited patient factors were financial issues, patient education and compliance and attendance issues. There were notable differences in the priority given to the various factors by the researcher, physicians, paramedical staff and the patients.Conclusion: We have discovered a large number of potential barriers and facilitators to care that may potentially be influencing the care of patients with diabetes within primary care in Tunisia, a low/ middle income country. An appreciation and understanding of these factors is essential in order to develop culturally appropriate interventions to improve the care of people with diabetes.