GPs' perspectives of type 2 diabetes patients' adherence to treatment: A qualitative analysis of barriers and solutions

Abstract

BackgroundThe problem of poor compliance/adherence to prescribed treatments is very complex. Health professionals are rarely being asked how they handle the patient's (poor) therapy compliance/adherence. In this study, we examine explicitly the physicians' expectations of their diabetes patients' compliance/adherence. The objectives of our study were: (1) to elicit problems physicians encounter with type 2 diabetes patients' adherence to treatment recommendations; (2) to search for solutions and (3) to discover escape mechanisms in case of frustration.MethodsIn a descriptive qualitative study, we explored the thoughts and feelings of general practitioners (GPs) on patients' compliance/adherence. Forty interested GPs could be recruited for focus group participation. Five open ended questions were derived on the one hand from a similar qualitative study on compliance/adherence in patients living with type 2 diabetes and on the other hand from the results of a comprehensive review of recent literature on compliance/adherence. A well-trained diabetes nurse guided the GPs through the focus group sessions while an observer was attentive for non-verbal communication and interactions between participants. All focus groups were audio taped and transcribed for content analysis. Two researchers independently performed the initial coding. A first draft with results was sent to all participants for agreement on content and comprehensiveness.ResultsGeneral practitioners experience problems with the patient's deficient knowledge and the fact they minimize the consequences of having and living with diabetes. It appears that great confidence in modern medical science does not stimulate many changes in life style. Doctors tend to be frustrated because their patients do not achieve the common Evidence Based Medicine (EBM) objectives, i.e. on health behavior and metabolic control. Relevant solutions, derived from qualitative studies, for better compliance/adherence seem to be communication, tailored and shared care. GPs felt that a structured consultation and follow-up in a multidisciplinary team might help to increase compliance/adherence. It was recognized that the GP's efforts do not always meet the patients' health expectations. This initiates GPs' frustration and leads to a paternalistic attitude, which may induce anxiety in the patient. GPs often assume that the best methods to increase compliance/adherence are shocking the patients, putting pressure on them and threatening to refer them to hospital.ConclusionGPs identified a number of problems with compliance/adherence and suggested solutions to improve it. GPs need communication skills to cope with patients' expectations and evidence based goals in a tailored approach to diabetes care.

Associations between diabetes self-management and microvascular complications in patients with type 2 diabetes

“…Previous studies have suggested that individuals with diabetes may not follow recommended guidelines for diet and exercise management [12]. Some studies have found that poor diabetes self-management among diabetes patients led to longterm diabetic complications [13,14].…”

A Qualitative Study of Perceived Responsibility and Self-Blame in Type 2 Diabetes: Reflections of Physicians and Patients

“…27,[32][33][34][35][36][37][38] Similarly, physicians are often frustrated by patients' difficulties integrating self-care into their lifestyles. [39][40][41] Thus, understanding patients' struggle to achieve treatment goals and physicians' responses to patients who are struggling to integrate selfcare into their lifestyles is important for understanding the physician-patient relationship in type 2 diabetes.…”

Limits and strategies of health professionals on adherence to treatment of diabetes: integrative review

“…19 Therefore, knowing the language of the community, involve family members and integrate them into the educational process is essential in the accession process. 31,32 This stance is intrinsically related to a concern with empathy established for the user, a factor that favors the approach of client health services, contributes to increase their motivation and therefore adherence to diabetes treatment. 33 Beyond Empathy, the host was cited as an important tool in the service and is a determinant in the consequent user satisfaction therefore also associated with a listening RF allows all health professionals to better understand the problems faced by the user, making this pose a mechanism for reasoning guidelines pipeline alternatives that are viable.…”