Exploring Canadian Physicians' Experiences With Type 2 Diabetes Care for Adult Indigenous Patients

Crowshoe, Lynden; Henderson, Rita; Green, Michael E.; Jacklin, Kristen; Walker, Leah; Calam, Betty

doi:10.1016/j.jcjd.2017.06.012

Cited by 19 publications

(29 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, historical trauma makes it likely that First Nations people avoid healthcare services [25]. Due to the inequitable diabetes care received by Indigenous peoples, including access to providers and programs, there have been calls for cultural mentorship to increase the knowledge of non-Indigenous providers of the social and historical context influencing patients healthcare decisions, and moving beyond cultural competency to understanding culture as a relational and fluid process [26].…”

Section: Discussionmentioning

confidence: 99%

Working towards a better understanding of type 2 diabetes care organization with First Nations communities: a qualitative assessment

2020

View full text Add to dashboard Cite

Background: Diabetes care is suboptimal in First Nations populations. Innovative and culturally-relevant approaches are needed to promote proactive organization of diabetes care for diabetes patients on-reserve in Canada. The Reorganizing the Approach to Diabetes care through the Application of Registries (RADAR) model is one strategy to improve care: an integrated disease registry and electronic health record for community healthcare workers with centralized care coordination. The aim of this study was to qualitatively assess the organization of type 2 diabetes care in participating communities in Alberta, Canada, at baseline prior to implementing RADAR.Methods: Using qualitative description, we purposefully sampled healthcare workers involved in diabetes care at each health center. We used the 5Rs framework (i.e., Recognize, Register, Resource, Relay, Recall) to inform the baseline assessment and conducted group interviews in 6 communities with 16 healthcare workers. Detailed notes were taken and validated by participants. Data was managed using ATLAS.ti 8 and analyzed using content analysis. Results: We found strong commitment and effort by local healthcare workers to support people living with type 2 diabetes in their communities. However, healthcare workers were limited in their ability to identify (i.e., recognize), track (i.e., register and relay) and manage (i.e., resource and recall) people with type 2 diabetes as proposed by the 5Rs framework. The organization of diabetes care was often reactive and dependent on patients' abilities to navigate the health system. Interestingly, participants talked about the 5Rs in relationship to one another, not in a linear or isolated manner. Conclusions: Overall, the organization of diabetes care in participating communities did not align with the recommended approach of the 5Rs framework. In addition, we propose "reimagining" the 5Rs to reflect the interdependence and mediation of components situated within human and financial resources. This will better equip healthcare workers to assess, plan and execute organized and proactive diabetes care. However, the onus on people living with type 2 diabetes to engage with healthcare services remains a concern. Trial registration: ISRCTN.com, ISRCTN14359671.

show abstract

Section: Discussionmentioning

confidence: 99%

Working towards a better understanding of type 2 diabetes care organization with First Nations communities: a qualitative assessment

2020

View full text Add to dashboard Cite

show abstract

“…There was a tendency to soften the impact of information given to the COPD patients about death, and HCPs felt unprepared and described anxiety and discomfort. 6 Crowshoe et al [26] In-depth semi-structured telephone Grounded theory, using NVivo…”

Section: Individualizing the Professional Approach Within The Clinicamentioning

confidence: 99%

“…Patients' specific cultural contexts could also impact their understanding of the chronic disease, which HCPs had to take into account in clinical encounters. This was especially clear in the papers addressing HCPs' experiences working with ethnic minority groups and indigenous patients [26,33]. Ethnic minorities were perceived by HCPs as more difficult to reach and cooperate with than most other patients.…”

Section: Individualizing the Professional Approach Within The Clinicamentioning

confidence: 99%

“…Ethnic minorities were perceived by HCPs as more difficult to reach and cooperate with than most other patients. Here, HCPs also expressed challenges related to their own and colleagues' lack of knowledge and cultural competence [26]. In particular, conducting consultations in which the HCP was dependent upon a translator complicated the patient-provider relationship [40].…”

Section: Individualizing the Professional Approach Within The Clinicamentioning

confidence: 99%

See 1 more Smart Citation

Working with patients suffering from chronic diseases can be a balancing act for health care professionals - a meta-synthesis of qualitative studies

Holmen

Larsen

Sallinen

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

Background: The number of patients with long-term chronic diseases is increasing. These patients place a strain on health care systems and health care professionals (HCPs). Presently, we aimed to systematically review the literature on HCPs' experiences working with patients with long-term chronic diseases such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD). Method: A systematic search of papers published between 2002 and July 2019 was conducted in the Embase, AMED, PsycINFO, MEDLINE, CINAHL, and COCHRANE databases to identify studies reporting qualitative interviews addressing HCPs' experiences working with adults with COPD, CKD or type 2 diabetes. An interdisciplinary research group were involved in all phases of the study. With the help of NVivo, extracts of each paper were coded, and codes were compared across papers and refined using translational analysis. Further codes were clustered in categories that in turn formed overarching themes. Results: Our comprehensive search identified 4170 citations. Of these, 20 papers met our inclusion criteria. Regarding HCPs' experiences working with patients with COPD, CKD, or type 2 diabetes, we developed 10 subcategories that formed three overarching main themes of work experiences: 1) individualizing one's professional approach within the clinical encounter; 2) managing one's emotions over time; 3) working to maintain professionalism. Overall these three themes suggest that HCPs' work is a complex balancing act depending on the interaction between patient and professional, reality and professional ideals, and contextual support and managing one's own emotions.

show abstract

Section: (Table 4 Overview Of the Themes And Categories About Here)mentioning

confidence: 99%

Working with patients suffering from chronic diseases – a balancing act for health care professionals. A meta-synthesis of qualitative studies

Holmen

Larsen

Sallinen

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: The number of patients with long-term chronic diseases is increasing. These patients place a strain on health care systems and health care professionals (HCPs). Presently, we aimed to systematically review the literature on HCPs’ experiences working with patients with long-term chronic diseases such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD). Method: A systematic search of papers published between 2002 and July 2019 was conducted in the Embase, AMED, PsycINFO, MEDLINE, CINAHL, and COCHRANE databases to identify studies reporting qualitative interviews addressing HCPs’ experiences working with adults with COPD, CKD or type 2 diabetes. An interdisciplinary research group were involved in all phases of the study. With the help of NVivo, extracts of each paper were coded, and codes were compared across papers and refined using translational analysis. Further codes were clustered in categories that in turn formed overarching themes. Results : Our comprehensive search identified 4170 citations. Of these, 20 papers met our inclusion criteria. Regarding HCPs’ experiences working with patients with COPD, CKD, or type 2 diabetes, we developed 10 sub-categories that formed three overarching main themes of work experiences: 1) individualizing one’s professional approach within the clinical encounter; 2) managing one’s emotions over time; 3) working to maintain professionalism. Overall these three themes suggest that HCPs’ work is a complex balancing act depending on the interaction between patient and professional, reality and professional ideals, and contextual support and managing one’s own emotions. Conclusion: Few qualitative studies highlighted HCPs’ general working experiences, as they mainly focused on the patients’ experiences or HCPs’ experiences of using particular clinical procedures. This study brings new insights about the complexity embedded in HCPs’ work in terms of weighing different, often contrasting aspects, in order to deliver appropriate practice. Acknowledging, discussing and supporting this complexity can empower HCPs to avoid burning out. Leaders, health organizations, and educational institutions have a particular responsibility to provide HCPs with thorough professional knowledge and systematic support.

show abstract

Exploring Canadian Physicians' Experiences With Type 2 Diabetes Care for Adult Indigenous Patients

Abstract: Adaptations in diabetes care by physicians grounded in the historical, social and cultural contexts of their Indigenous patients offer opportunities for improving care quality, but policy and health system supports and structural competency are needed.

Cited by 19 publications

References 31 publications

Working towards a better understanding of type 2 diabetes care organization with First Nations communities: a qualitative assessment

Working towards a better understanding of type 2 diabetes care organization with First Nations communities: a qualitative assessment

Working with patients suffering from chronic diseases can be a balancing act for health care professionals - a meta-synthesis of qualitative studies

Working with patients suffering from chronic diseases – a balancing act for health care professionals. A meta-synthesis of qualitative studies

Contact Info

Product

Resources

About