Managing diabetes mellitus with comorbidities in primary healthcare facilities in urban settings: a qualitative study among physicians in Odisha, India

Sandipana Pati,Marjan Van Den Akker,Krushna Chandra Sahoo,Sanghamitra Pati,F G Schellevis,Jako S Burgers

doi:10.1186/s12875-021-01454-4

Abstract

AimTo explore the perceived barriers and facilitators in the management of the patients having diabetes with comorbidities by primary care physicians.MethodsA qualitative In-Depth Interview study was conducted among the primary care physicians at seventeen urban primary health care centres at Bhubaneswar city of Odisha, India. The digitally recorded interviews were transcribed verbatim and translated into English. The data were analysed using thematic analysis.ResultsBarriers related to physicians, patients and health system were identified. Physicians felt lack of necessary knowledge and skills, communication skills and overburdening due to multiple responsibilities to be major barriers to quality care. Patients’ attitude and beliefs along with socio-economic status played an important role in treatment adherence and in the management of their disease conditions. Poor infrastructure, irregular medicine supply, and shortage of skilled allied health professionals were also found to be barriers to optimal care delivery, as was the lack of electronic medical records and personal treatment records.ConclusionComprehensive guidelines with on the job training for capacity building of the physicians and creation of multidisciplinary teams at primary care level for a more holistic approach towards management of diabetes with comorbidities could be the way forward to optimal delivery of care.

Highlights

Optimal care of patients with diabetes mellitus continues to be a challenge to health systems around the globe. [1] Given the chronic and complex nature of the disease, the presence of additional comorbidities further multiplies this challenge
Three major themes emerged: 1) Health system preparedness to manage diabetes comorbidities, 2) Challenges faced by physician to treat diabetes comorbidities, and 3) Patients’ related factors in management of diabetes comorbidities. (Table 2) The findings are presented under each theme and category with quotes from the participants
While lack of regular supply of medicines, poor laboratory services in the health facility, lack of trained human resources were some of the common barriers for all physicians, few facilitators like Non-Communicable Disease (NCD) awareness campaigns and periodic follow up of the patients by the community level health workers helped in improving the quality of management

Summary

Introduction

Optimal care of patients with diabetes mellitus continues to be a challenge to health systems around the globe. [1] Given the chronic and complex nature of the disease, the presence of additional comorbidities further multiplies this challenge. Pati et al BMC Fam Pract (2021) 22:99 systems towards infectious disease management, limited resources and fragmented primary care, pose an uphill task for the primary care physicians in managing patients with diabetes and comorbidities. It is imperative to understand the challenges faced by primary care health providers in LMICs settings towards the management of patients with diabetes and comorbidities. Lall et al in their study conducted in a rural district of India on challenges in primary care for diabetes and hypertension management have found fragmented care and a poor health information system as major barriers faced by physicians in quality management [15]

Methods

Results

Discussion

Conclusion