RT Journal Article
SR Electronic
T1 Barriers to effective management of type 2 diabetes in primary care: qualitative systematic review
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e114
OP e127
DO 10.3399/bjgp16X683509
VO 66
IS 643
A1 Bruno Rushforth
A1 Carolyn McCrorie
A1 Liz Glidewell
A1 Eleanor Midgley
A1 Robbie Foy
YR 2016
UL http://bjgp.org/content/66/643/e114.abstract
AB Background Despite the availability of evidence-based guidance, many patients with type 2 diabetes do not achieve treatment goals.Aim To guide quality improvement strategies for type 2 diabetes by synthesising qualitative evidence on primary care physicians’ and nurses’ perceived influences on care.Design and setting Systematic review of qualitative studies with findings organised using the Theoretical Domains Framework.Method Databases searched were MEDLINE, Embase, CINAHL, PsycInfo, and ASSIA from 1980 until March 2014. Studies included were English-language qualitative studies in primary care of physicians’ or nurses’ perceived influences on treatment goals for type 2 diabetes.Results A total of 32 studies were included: 17 address general diabetes care, 11 glycaemic control, three blood pressure, and one cholesterol control. Clinicians struggle to meet evolving treatment targets within limited time and resources, and are frustrated with resulting compromises. They lack confidence in knowledge of guidelines and skills, notably initiating insulin and facilitating patient behaviour change. Changing professional boundaries have resulted in uncertainty about where clinical responsibility resides. Accounts are often couched in emotional terms, especially frustrations over patient compliance and anxieties about treatment intensification.Conclusion Although resources are important, many barriers to improving care are amenable to behaviour change strategies. Improvement strategies need to account for differences between clinical targets and consider tailored rather than ‘one size fits all’ approaches. Training targeting knowledge is necessary but insufficient to bring about major change; approaches to improve diabetes care need to delineate roles and responsibilities, and address clinicians’ skills and emotions around treatment intensification and facilitation of patient behaviour change.