Barriers and facilitators to evidence based care of type 2 diabetes patients: experiences of general practitioners participating to a quality improvement program

Geert Goderis,Jan Heyrman,Chantal Mathieu,Karen Hannes,Liesbeth Borgermans,Carine Van Den Broeke,Richard Grol

doi:10.1186/1748-5908-4-41

Geert Goderis, Jan Heyrman + Show 5 more

Open Access

https://doi.org/10.1186/1748-5908-4-41

Copy DOI

Journal: Implementation Science	Publication Date: Jul 22, 2009
Citations: 83	License type: cc-by

Affiliation: KU Leuven, Radboud University Nijmegen

Abstract

ObjectiveTo evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs) who participated in an 18-month quality improvement program (QIP). This QIP was implemented to promote compliance with international guidelines.MethodsTwenty out of the 120 participating GPs in the QIP underwent semi-structured interviews that focused on three questions: 'Which changes did you implement or did you observe in the quality of diabetes care during your participation in the QIP?' 'According to your experience, what induced these changes?' and 'What difficulties did you experience in making the changes?'ResultsMost GPs reported that enhanced knowledge, improved motivation, and a greater sense of responsibility were the key factors that led to greater compliance with diabetes care guidelines and consequent improvements in diabetes care. Other factors were improved communication with patients and consulting specialists and reliance on diabetes nurse educators. Some GPs were reluctant to collaborate with specialists, and especially with diabetes educators and dieticians. Others blamed poor compliance with the guidelines on lack of time. Most interviewees reported that a considerable minority of patients were unwilling to change their lifestyles.ConclusionQualitative research nested in an experimental trial may clarify the improvements that a QIP may bring about in a general practice, provide insight into GPs' approach to diabetes care and reveal the program's limits. Implementation of a QIP encounters an array of cognitive, motivational, and relational obstacles that are embedded in a patient-healthcare provider relationship.

Highlights

Landmark studies have demonstrated that intensive management of hyperglycemia, hyperlipidemia, and hypertension significantly reduces morbidity and mortality in patients with type 2 diabetes mellitus (T2DM) [1,2,3,4,5,6,7,8,9]
Our study reports on 20 general practitioners (GPs) who participated in an 18-month quality improvement program (QIP)
Two GPs refused to participate in the interview and were replaced by the GP in line

Summary

Introduction

Landmark studies have demonstrated that intensive management of hyperglycemia, hyperlipidemia, and hypertension significantly reduces morbidity and mortality in patients with type 2 diabetes mellitus (T2DM) [1,2,3,4,5,6,7,8,9]. (e.g., nephropathy, retinopathy, diabetic foot) and/or macrovascular (e.g., myocardial infarction, stroke) complications become apparent Prevention of these complications rests on timely institution of drug therapy by the prescribing physician, usually a general practitioner (GP), and the patient's compliance with the treatment regimen and willingness to make lifestyle changes. Our study reports on 20 GPs who participated in an 18-month quality improvement program (QIP) The aim of this program was to improve diabetes-related patient outcomes through the implementation of evidence-based guideline recommendations. We conducted a complementary, qualitative study (January to April 2008) nested in the controlled trial, to gain better insight into what changes the GPs had experienced To fully understand these changes, we relied on an 'implementation model' based on the one described by Grol et al, 2004 [25,26,27]

Methods

Results

Conclusion