Abstract
Healthcare professionals’ level of engagement in diabetes care and their perceptions of challenges to effective diabetes care are key indicators impacting diabetes management. This study investigated diabetes-related healthcare services provided in Nepal, and explored healthcare professionals’ opinions of the barriers to, and strategies for, effective diabetes care. In-depth face-to-face interviews were conducted with thirty healthcare professionals providing healthcare or medication-related services to patients with type 2 diabetes within Kathmandu Valley. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Participants were physicians, dieticians, nurses and pharmacy staff. Diabetes care services varied between healthcare institutions, between healthcare professionals and between patients, with the overall patient-care model reported as sub-optimal. Diabetes related services were mostly limited to physician-patient consultations. Only a few hospitals or clinics provided additional diabetes education classes, and individual dietician or nurse consultations. Limited collaboration, large patient-load and workforce shortages (particularly lack of diabetes educators) were reported as major issues affecting diabetes care. Regulatory measures to address healthcare system barriers were identified as potential facilitators for effective diabetes management. Whilst the findings are specific to Nepal, there are lessons to be learnt for other healthcare settings as the fundamental barriers to optimal diabetes care appear to be similar worldwide.
Highlights
Nepal, like most countries in the world, is facing an increasing burden of type 2 diabetes (T2D), in urban areas [1,2]
The participants were recruited from 13 hospitals and clinics providing modern healthcare services; and six clinics providing traditional (Ayurvedic) services
Diabetes educators could not be recruited for interviews as we could not identify any healthcare professionals with formal diabetes educator certification or who identified themselves as ‘Diabetes Educators’
Summary
Like most countries in the world, is facing an increasing burden of type 2 diabetes (T2D), in urban areas [1,2]. Diabetes is a complex chronic condition, associated with debilitating complications [3]. Lifestyle management, including a balanced healthy diet and adequate physical exercise, together with anti-diabetic medications are the basis of diabetes treatment [4]. Considering the nature of diabetes and its management, different healthcare professionals (HCPs) have unique and significant roles to play in diabetes care. The HCPs most commonly involved in day-to-day diabetes care include the general (or family) medical practitioner/ physician, endocrinologist, dietician, diabetes educator, nurse, pharmacist and podiatrist. Other specialists (such as, cardiologist, ophthalmologist and nephrologist) are involved, in assessing and managing the complications of diabetes. It is advocated that these HCPs work in collaboration with patients and their families to provide an integrated care focused on patient needs
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