Problems encountered by primary care physicians in the care of patients with diabetes

Ch, Jacques; Rl, Jones

doi:10.1001/archfami.2.7.739

Cited by 17 publications

(12 citation statements)

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“…It is important to note that this variable did not measure whether the physician gave the diet recommendation but rather whether the patient remembered and/or reported it. This finding, which was the only management variable significant in multivariate analysis, underscores the complexity of the physician-patient interaction(31) in dietary management of NIDDM, as well as known difficulties for physicians and patients alike in NIDDM dietary management(32)(33)(34).…”

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confidence: 67%

Characteristics Related to Poor Glycemic Control in NIDDM Patients in Community Practice

et al. 1997

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1) Poor glycemic control may reflect progressive failure of islet function, although the independent relationships of C-peptide level and time since diagnosis are consistent with concepts of heterogeneous mechanisms underlying NIDDM. 2) Despite the important relationships of biological characteristics of NIDDM to glycemic control, patient attitudes and self-care ability may be useful targets for designing management strategies for certain poorly controlled patients.

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confidence: 67%

Characteristics Related to Poor Glycemic Control in NIDDM Patients in Community Practice

et al. 1997

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“…As a result, patients may deliberately take drug holidays or skip doses of medication(s) without the knowledge of their physician. The implication would be that the physician may attribute the lack of response to drug therapy as therapeutic ineffectiveness rather than medication nonadherence and may take the decision of either increasing the dose of the current medications or add another drug 16,35…”

Section: Discussionmentioning

confidence: 99%

“…However, ensuring that patients take oral hypoglycemic medications as prescribed and achieve normal or near normal blood glucose control is among the most common challenges encountered by physicians and other health care providers involved in the treatment of patients with diabetes 16. This needs to be addressed during all phases of diabetes treatment17 which makes it imperative to understand factors affecting patients’ adherence to medication in order to identify the areas upon which counseling should be focused as well as assisting in the development of future interventions to improve adherence and outcomes of type 2 diabetes treatment.…”

Section: Introductionmentioning

confidence: 99%

Factors contributing to nonadherence to oral hypoglycemic medications among ambulatory type 2 diabetes patients in Southwestern Nigeria

Adisa

Alutundu

Fakeye

2009

Pharmacy Practice (Internet)

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Objective:The overall goal of the study was to evaluate the probable reasons for patients’ nonadherence to prescribed oral hypoglycemic medications in an ambulatory care setting in Nigeria with a view to identifying points for necessary intervention to improve adherence and treatment outcomes. Also, the recommended non-drug management options for diabetes patients with emphasis on self monitoring of blood glucose were assessed.Methods:A cross-sectional study was conducted at a 200-bed secondary health care facility in Southwestern Nigeria between 2nd April and 31st May 2008. Copies of pre-tested questionnaire were administered directly to 121 ambulatory patients with type 2 diabetes at the study site. Information on socio-demographic characteristic, probable barriers that affect adherence to prescribed oral hypoglycemic medications, non-drug treatment options for diabetes, and patients’ self management efforts were obtained. Descriptive and chi-square statistics were used to evaluate the distribution of respondents’ opinion.Results:The response rate was almost 100%. The commonly cited intentional nonadherence practice included dose omission (70.2%). Almost 50% respondents were fed up with daily ingestion of drugs and 19.8% were inconvenienced with taking medications outside home and gave these as reasons for the dose omission. Forgetfulness (49.6%) and high cost of medication (35.5%) were mentioned as major non-intentional reasons for nonadherence. Aside oral medications, 82.6% and 95.0% of respondents respectively, reported moderate exercise and dietary restrictions as part of the prescribed treatment modalities. More than two third of respondents (81.8%) had never monitored blood glucose by themselves. Significant association exist between sex, occupation and patients’ tendencies to forget doses of prescribed oral medications (p<0.05).Conclusion:Nonadherence behaviors among ambulatory patients with type 2 diabetes occur mostly, as omission and forgetfulness of doses of medication. Efforts are needed to increase the medication adherence and self management practices of these patients in Nigeria so they can realize the full benefits of prescribed therapies.

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“…In surveys, primary care physicians frequently report difficulties with patients' motivation and understanding of diabetes, dietary and medication nonadherence, and weight control (23)(24)(25). Other barriers included inadequate reimbursement, insufficient time, and lack of support personnel outside of the office (25).…”

Section: Provider Barriers Survey and Organizational Characteristicsmentioning

confidence: 99%

Barriers to Providing Diabetes Care in Community Health Centers

Chin¹,

Cook²,

Jin³

et al. 2001

Diabetes Care

151

112

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OBJECTIVE -We aimed to identify barriers to improving care for individuals with diabetes in community health centers. These findings are important because many such patients, as in most other practice settings, receive care that does not meet evidence-based standards. RESEARCH DESIGN AND METHODS -In 42Midwestern health centers, we surveyed 389 health providers and administrators about the barriers they faced delivering diabetes care. We report on home blood glucose monitoring, HbA 1c tests, dilated eye examinations, foot examinations, diet, and exercise, all of which are a subset of the larger clinical practice recommendations of the American Diabetes Association (ADA).RESULTS -Among the 279 (72%) respondents, providers perceived that patients were significantly less likely than providers to believe that key processes of care were important (overall mean on 30-point scale: providers 26.8, patients 18.2, P = 0.0001). Providers were more confident in their ability to instruct patients on diet and exercise than on their ability to help them make changes in these areas. Ratings of the importance of access to care and finances as barriers varied widely; however, Ͼ25% of the providers and administrators agreed that significant barriers included affordability of home blood glucose monitoring, HbA 1c testing, dilated eye examination, and special diets; nonproximity of ophthalmologist; forgetting to order eye examinations and to examine patients' feet; time required to teach home blood glucose monitoring; and language or cultural barriers.CONCLUSIONS -Providers in health centers indicate a need to enhance behavioral change in diabetic patients. In addition, better health care delivery systems and reforms that improve the affordability, accessibility, and efficiency of care are also likely to help health centers meet ADA standards of care.

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Problems encountered by primary care physicians in the care of patients with diabetes

Cited by 17 publications

References 0 publications

Characteristics Related to Poor Glycemic Control in NIDDM Patients in Community Practice

Characteristics Related to Poor Glycemic Control in NIDDM Patients in Community Practice

Factors contributing to nonadherence to oral hypoglycemic medications among ambulatory type 2 diabetes patients in Southwestern Nigeria

Barriers to Providing Diabetes Care in Community Health Centers

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