Considering shared power and responsibility: Diabetic patients’ experience with the PCMH care model (original) (raw)
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Patients’ perspectives on how to improve diabetes care and self-management: qualitative study
BMJ Open
ObjectivePeople living with diabetes need and deserve high-quality, individualised care. However, providing such care remains a challenge in many countries, including Canada. Patients’ expertise, if acknowledged and adequately translated, could help foster patient-centred care. This study aimed to describe Expert Patients’ knowledge, wisdom and advice to others with diabetes and to health professionals to improve diabetes self-management and care.Design and methodsWe recruited a convenience sample of 21 men and women. Participants were people of diverse backgrounds who are Patient Partners in a national research network (hereafter Expert Patients). We interviewed and video-recorded their knowledge, wisdom and advice for health professionals and for others with diabetes. Three researchers independently analysed videos using inductive framework analysis, identifying themes through discussion and consensus. Expert Patients were involved in all aspects of study design, conduct, analysis...
Journal of Clinical Nursing, 2019
Aims and objectivesTo explore the perspectives of patients and health professionals on facilitators and barriers to care in a diabetes clinic in urban South Africa.BackgroundAlthough much attention has been given to the science behind diabetes management, a qualitative approach to exploring experiences, facilitators and barriers to care may have considerable value in understanding and improving diabetes care.DesignWe conducted a qualitative study in the context of a 3‐year collaboration at a diabetes clinic. The present study formed part of the preparatory phase to the larger project.MethodsLinguistically and culturally matched research assistants collected data over a period of 18 months. Methods included interviews, focus groups, ethnographic observations and informal discussions with 38 patients and health professionals. Data from each participant group were transcribed, translated and analysed using reflexive thematic analysis principles and thereafter triangulated. The Standard...
Communication during patient-provider encounters regarding diabetes self-management
Family medicine
Diabetes is a common chronic illness with potentially severe complications. The risk of complications is reduced through controlling blood sugar, lipids, and blood pressure. While medical intervention is important, substantial self-management on the part of patients is required to achieve good control. Patients often find self-management difficult, particularly diet and exercise modification. Clinicians face barriers as well, including lack of time, poor reimbursement, and difficulty changing their clinical practice patterns. We hypothesized that a strong focus on readily measured disease indicators competes with patients' agendas relating to symptoms and their day-to-day social context. We recorded clinical encounters to study communication about self-management in context. Recordings were transcribed verbatim and analyzed, primarily using a grounded theory approach. We found that clinicians often focused their communication on quantitative measures such as blood pressure and g...
Primary care diabetes, 2016
The purpose of this study was to examine how patients with diabetes and their primary care physicians identify and discuss visit priorities prior to and during visits. We conducted a qualitative study involving patients with diabetes (4 focus groups, n=29) and primary care physicians (6 provider practice meeting discussions, n=67). Four key themes related to prioritization were identified: 1) the value of identifying visit priorities before the visit; 2) challenges to negotiating priorities during the time-limited visit; 3) the importance of "non-medical" priorities; and 4) the need for strategies to help patients prepare for visits. Both patients and physicians felt that identifying a concise list of key priorities in advance of the visit could help establish collaborative visit agendas and treatment plans. Identifying and communicating mutually agreed upon priorities for discussion is a key challenge for time-limited primary care visits. Communication between primary car...
PATIENT VOICE: APPRECIATIVE INQUIRY INTO LIVING WELL WITH DIABETES
This study explores the question “What factors contribute to successful self-management of chronic disease/diabetes from the patients’ perspective?” It analyses individual interviews with 13 adults with diabetes about living well with diabetes, and their dreams of enhanced conditions for successful self-management of diabetes. The study has two assumptions: 1) patients have unique, particular, and holistic knowledge of their health and self-management practices, 2) Appreciative Inquiry locates and enhances the positive and life-giving forces in individuals and systems. Appreciative Inquiry is thus seen as an appropriate methodology to use in the discovery of the positive, life-giving attitudes, actions, and dreams of the participants. Thematic Analysis of the interview data identifies that positive personal qualities, reciprocal interpersonal support, and experiential expertise are three themes which interact and enable participants to live well with diabetes. Frank’s illness narrative theory is used to frame the quest narrative manifest in the overarching theme, simultaneously embracing diabetes management and life.
Patient preference and adherence, 2015
Insightful accounts of patient experience within a health care system can be valuable for facilitating improvements in service delivery. The aim of this study was to explore patients' perceptions and experiences regarding a tertiary hospital Diabetes and Endocrinology outpatient service for the management of type 2 diabetes mellitus (T2DM). Nine patients participated in discovery interviews with an independent trained facilitator. Patients' stories were synthesized thematically using a constant comparative approach. Three major themes were identified from the patients' stories: 1) understanding T2DM and diabetes management with subthemes highlighting that specialist care is highly valued by patients who experience a significant burden of diabetes on daily life and who may have low health literacy and low self confidence; 2) relationships with practitioners were viewed critical and perceived lack of empathy impacted the effectiveness of care; and 3) impact of health care ...
The Journal of clinical endocrinology and metabolism/Journal of clinical endocrinology & metabolism, 2024
Diabetes can be an arduous journey both for people with diabetes (PWD) and their caregivers. While the journey of every person with diabetes is unique, common themes emerge in managing this disease. To date, the experiences of PWD have not been fully considered to successfully implement the recommended standards of diabetes care in practice. It is critical for health-care providers (HCPs) to recognize perspectives of PWD to achieve optimal health outcomes. Further, existing tools are available to facilitate patient-centered care but are often underused. This statement summarizes findings from multistakeholder expert roundtable discussions hosted by the Endocrine Society that aimed to identify existing gaps in the management of diabetes and its complications and to identify tools needed to empower HCPs and PWD to address their many challenges. The roundtables included delegates from professional societies, governmental organizations, patient advocacy organizations, and social enterprises committed to making life better for PWD. Each section begins with a clinical scenario that serves as a framework to achieve desired health outcomes and includes a discussion of resources for HCPs to deliver patient-centered care in clinical practice. As diabetes management evolves, achieving this goal will also require the development of new tools to help guide HCPs in supporting PWD, as well as concrete strategies for the efficient uptake of these tools in clinical practice to minimize provider burden. Importantly, coordination among various stakeholders including PWD, HCPs, caregivers, policymakers, and payers is critical at all stages of the patient journey.
PLOS ONE, 2020
Background The burden of treatment can overwhelm people living with type 2 diabetes and lead to poor treatment fidelity and outcomes. Chronic care programs must consider and mitigate the burden of treatment while supporting patients in achieving their goals. Objective To explore what patients with type 2 diabetes and their health providers consider are the workload and the resources they must mobilize, i.e., their capacity, to shoulder it. Methods We conducted focus groups comprised of 30 patients and 32 clinicians from three community health centers in Chile implementing the Chronic Care Model to reduce cardiovascular risk in patients with type 2 diabetes. Transcripts were analyzed using thematic content analysis techniques illuminated by the Minimally Disruptive Medicine framework. Findings Gaining access to and working with their clinicians, implementing complex medication regimens, and changing lifestyles burdened patients. To deal with the distress of the diagnosis, difficulties achieving disease control, and fear of complications, patients drew capacity from their family (mostly men), social environment (mostly women), lay expertise, and spirituality. Clinicians found that administrative tasks, limited formulary, and protocol rigidity hindered their ability to modify care plans to reduce patient workload and support their capacity.
Family Experience of Caring for a Diabetes Mellitus Patient: A Qualitative Study
Jurnal Ners
Introduction: Diabetes mellitus is a chronic disease that requires lifelong care. The treatment of diabetes mellitus patients at home requires a family role so then the patients can optimize their care. The diabetes complications can be reduced as a result. The aim of this study was to explore the family experience of treating diabetes mellitus patients at home.Methods: A semi-structured phenomenological approach including inductive thematic analysis was used in this research. Thirteen family members of diabetes patients participated in the discussion. Participant recruitment was focused on families that have treated diabetes patients for more than 1 year with no complications. Data saturation occurred after 2-3 meetings per participant.Results: The experiences of the family members while caring for diabetes mellitus patient can be used to determine the presence of 5 themes: family feelings that appear when caring for diabetes mellitus patients, patient adherence to taking medicati...