System Barriers Associated With Diabetes Management in Primary Care

Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews

“…Qualitative: trustworthiness, credibility, confirmability, dependability and transferrability • No • Professionals and administrative staff Facilitators and barriers Sales AE 2012 [ 102 ] The use of data for process and quality improvement in long-term care and home care: a systematic review of the literature Systematic review To determine how the resident assessment instrument minimum data set (RAI) have been used in process or quality improvement activities in the continuing care sector Inclusion criteria Discussed continuing care in a long-term care and health care setting; involved some form of intervention relating to quality or process improvement, and used RAI data in the quality or process improvement intervention. • 24 (quantitative) • Yes • Yes • Descriptive/narrative • No • No • Unclear Barriers only (in discussion; quality not relevant) Zhang J 2012 [ 103 ] System barriers associated with diabetes management in primary care Systematic review To explore system barriers to diabetes management in primary care and solutions that overcome the system barriers and the role of nurse practitioners in addressing these system barriers Inclusion criteria English only articles and articles specifically focused on system barriers for diabetes management in primary care settings were included Exclusion criteria None stated • 31 (both systematic reviews and primary studies) • Not stated • Not given • Unclear • Not stated • No • Unclear Facilitators and (largely) barriers Hoare K 2012 [ 53 ] The role of government policy in supporting nurse-led care in general practice in the UK, New Zealand and Australia: an adapted realist review Systematic review and realist review Realist review to examine the theory that clinical governance was the main driver to stimulate practice nurse development To examine the role of government policy in primary care and its association with nurse-led care in the UK, New Zealand and Australia between 1998 and 2009 Inclusion criteria Systematic review—the study had to report primary research involving practice nurses or demographical statistics of nurse-led clinics in general practice • 45 (mixed study types including policy documents) • Yes • Yes • Realist synthesis • Realist synthesis—the reviewer reads the paper to search for evidence that may support the initial theory and so contribute to fuller development of an explanatory model. No quality assessment tools were suitable for the systematic review • No • Unclear Facilitators and barriers Nam S 2011 [ 78 ] Barriers to diabetes management: patient and provider factors Systematic rev...…”

“…It includes the inadequate distribution of decision-making power (or ownership) among stakeholders [ 94 ] F: Board members are aligned with implementation plan [ 16 ] √ √ √ √ √ Technological advances [ 65 , 67 ] B/F: Those responsible for Clinical Decision Support System implementation are typically administrators, information technology managers, and clinicians, all of whom are increasingly pushed by technology [ 65 ] √ √ Organisation Culture Organisational planning and readiness [ 3 , 14 , 15 , 32 , 34 , 38 , 40 , 41 , 51 , 54 – 56 , 58 , 60 , 61 , 65 – 67 , 69 , 71 , 77 , 83 , 94 , 103 , 105 , 109 , 110 ] B/F: Receptiveness of the whole organisation [ 56 ] √ √ √ √ √ Leadership [ 14 – 16 , 31 , 32 , 34 , 41 , 52 – ...…”

Perceived Needs for Supported Self‐management of Type 2 Diabetes: A Qualitative Investigation of the Potential for a Web‐based Intervention

“…GPs have indicated that psychological counselling about modifying lifestyle factors, including weight, nutrition, and physical activity, is one of their most common roles in type 2 diabetes patient consultations (AIHW, ). However, both intrapersonal (e.g., low self‐efficacy; Bambling et al., ) and system‐level barriers (Zhang, Van Leuven, & Neidlinger, ) prevent GPs from addressing these issues in sufficient depth. It is also difficult for primary care practitioners to provide the frequency or intensity of support for self‐management that may be required (Fisher, Brownson, O'Toole, Anwuri, & Shetty, ), and this is particularly the case when patients present with comorbid psychological and/or emotional issues (Hajos, Polonsky, Twisk, Dain, & Snoek, ).…”

Partnering with diabetes educators to improve patient outcomes

“…Primary care providers often lack the time needed to effectively engage patients in self-management and would benefit from having access to diabetes education specialists or health coaches 63. Aspects of DSME can be provided in a number of ways and by various providers so long as the providers are sufficiently trained and supervised 64–67…”