Gaps and barriers in health-care provision for co-morbid diabetes and chronic kidney disease: a cross-sectional study

BMC Nephrology

Research Article

G. Fulcher¹  M. Gallagher²  P. G. Kerr³  R. Walker⁴  S. Ranasinha⁵  C. Lo⁶  H. Teede⁶  S. Zoungas⁷  G. Russell⁸ 

[1] Department of Diabetes and Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia;Department of Nephrology, Concord Hospital, Concord, New South Wales, Australia;The George Institute for Global Health, Sydney, New South Wales, Australia;Department of Nephrology, Monash Health, Clayton, Victoria, Australia;Department of Renal Medicine, Alfred Health, Prahran, Victoria, Australia;Diabetes and Vascular Research Program, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia;Diabetes and Vascular Research Program, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia;Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia;Diabetes and Vascular Research Program, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia;Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia;Department of Diabetes and Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia;School of Primary Health Care, Monash University, Notting Hill, Victoria, Australia;

关键词: Diabetes;    Chronic kidney disease;    Multi-morbidity;    Health-care;    Tertiary health-care;    Treatment gaps;    Barriers;   

DOI  :  10.1186/s12882-017-0493-x

 received in 2016-11-16, accepted in 2017-02-21,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundPatients with diabetes and chronic kidney disease (CKD) are a complex subset of the growing number of patients with diabetes, due to multi-morbidity. Gaps between recommended and received care for diabetes and chronic kidney disease (CKD) are evident despite promulgation of guidelines. Here, we document gaps in tertiary health-care, and the commonest patient-reported barriers to health-care, before exploring the association between these gaps and barriers.MethodsThis cross-sectional study recruited patients with diabetes and CKD (eGFR < 60 mL/min/1.73 m2) across 4 large hospitals. For each patient, questionnaires were completed examining clinical data, recommended care, and patient-reported barriers limiting health-care. Descriptive statistics, subgroup analyses by CKD stage and hospital, and analyses examining the relationship between health-care gaps and barriers were performed.Results308 patients, of mean age 66.9 (SD 11.0) years, and mostly male (69.5%) and having type 2 diabetes (88.0%), participated. 49.1% had stage 3, 24.7% stage 4 and 26.3% stage 5 CKD. Gaps between recommended versus received care were evident: 31.9% of patients had an HbA1c ≥ 8%, and 39.3% had a measured blood pressure ≥ 140/90 mmHg. The commonest barriers were poor continuity of care (49.3%), inadequate understanding/education about CKD (43.5%), and feeling unwell (42.6%). However, barriers associated with a failure to receive items of recommended care were inadequate support from family and friends, conflicting advice from and poor communication amongst specialists, the effect of co-morbidities on self-management and feeling unmotivated (all p < 0.05).ConclusionsBarriers to health-care varied across CKD stages and hospitals. Barriers associated with a deviation from recommended care were different for different items of care, suggesting that specific interventions targeting each item of care are required.

【 授权许可】

CC BY   
© The Author(s). 2017