Abstract
AimsAs quality in diabetes care includes patient centred support for self-management, investigating patients’ experiences upon diagnosis can help improve access to this element of care among diverse populations. This research explored this care in the context of recent national quality improvement initiatives which support self-management.MethodsSouth Asian and White European patients over 16 years with a recent (< 1 year) diagnosis of diabetes were recruited from 18 General Practitioner (GP) practices in three UK locations - Luton, West London and Leicester. A semi-structured qualitative interview was conducted with 47 patients.ResultsTwenty one out of 47 (45%) reported unmet support and information needs at diagnosis. Although there was a small proportion of participants (8 out of 47, 17% of all respondents) who felt they did not require any help or support with managing their diabetes because their GP had provided comprehensive and efficient care, there was an equal number who voiced a negative view of the care they had received to date. This concerned information giving, support and communication, suggesting that recently implemented national quality improvement interventions may not have been successful in improving all aspects of diabetes care, particularly those encouraging self-management. The emerging analysis led to consideration of concordance as an important concept through which to understand inequalities and improve access to quality diabetes care. In order to encourage self-management from the start, care providers need to be cognisant that patients are not homogeneous and be responsive to their different information needs and emotional responses to diagnosis.ConclusionsIn order to support self-management and deliver patient centred care in diverse populations, care providers will need to be adaptable to individual needs around diagnosis.
Highlights
The rising prevalence of diabetes in the UK [1] is well documented
Previous research has shown that there can be barriers to healthcare access that relate to ethnicity or culture, which culturally competent healthcare providers seek to mitigate [9,10] in order to provide equitable access and quality in diabetes care [11]
Our study shows that care varied for people with recent diabetes diagnosis at the three study sites, as not all recently diagnosed patients had access to all aspects of quality diabetes care and were met with a lack of support and information
Summary
The rising prevalence of diabetes in the UK [1] is well documented. We know that the South Asian population have a higher relative risk of diabetes and kidney complications [2,3] because of genetic, lifestyle or access factors [4,5]. Previous research has shown that there can be barriers to healthcare access that relate to ethnicity or culture, which culturally competent healthcare providers seek to mitigate [9,10] in order to provide equitable access and quality in diabetes care [11]. Quality care in diabetes includes support for people in managing their diabetes and was part of Standard 3 of the UK National Service Framework: ‘empowering people with diabetes’ through engagement and partnership in decision making [12]. The combination of quantitative and qualitative data which capture the processes of care and the experience of people who live with this complex chronic disease have the potential to help all stakeholders understand how to maximise access to effective diabetes prevention and management
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