Primary and tertiary health professionals’ views on the health-care of patients with co-morbid diabetes and chronic kidney disease – a qualitative study

BMC Nephrology

Research Article

Greg Fulcher¹  Dragan Ilic²  Kerry Murphy²  Timothy Usherwood³  Peter G Kerr⁴  Kevan Polkinghorne⁴  Rowan Walker⁵  Clement Lo⁶  Helena Teede⁶  Sophia Zoungas⁷  Grant Russell⁸  Martin Gallagher⁹ 

[1] Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia;Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia;Department of General Practice, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia;Department of Nephrology, Monash Health, Clayton, Victoria, Australia;Department of Renal Medicine, Alfred Health, Prahran, Victoria, Australia;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;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;The George Institute for Global Health, Sydney, NSW, Australia;School of Primary Health Care, Monash University, Clayton, Victoria, Australia;The George Institute for Global Health, Sydney, NSW, Australia;Department of Nephrology, Concord Hospital, Sydney, NSW, Australia;

关键词: Qualitative;    Focus groups;    Multi-morbidity;    Diabetes;    Chronic kidney disease;    Health-care;    Health-care delivery;    Primary care;    Tertiary care;   

DOI  :  10.1186/s12882-016-0262-2

 received in 2015-10-24, accepted in 2016-05-10,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundHealth-care for co-morbid diabetes and chronic kidney disease (CKD) is often sub-optimal. To improve health-care, we explored the perspectives of general practitioners (GPs) and tertiary health-care professionals concerning key factors influencing health-care of diabetes and CKD.MethodsA total of 65 health professionals were purposively sampled from Australia’s 2 largest cities to participate in focus groups and semi-structured interviews. Four focus groups were conducted with GPs who referred to 4 tertiary health services in Australia’s 2 largest cities, with 6 focus groups conducted with tertiary health-care professionals from the 4 tertiary health services. An additional 8 semi-structured interviews were performed with specialist physicians who were heads of diabetes and renal units. All discussions were facilitated by the same researcher, with discussions digitally recorded and transcribed verbatim. All qualitative data was thematically analysed independently by 2 researchers.ResultsBoth GPs and tertiary health-care professionals emphasised the importance of primary care and that optimal health-care was an inter-play between patient self-management and primary health-care, with specialist tertiary health-care support. Patient self-management, access to specialty care, coordination of care and a preventive approach were identified as key factors that influence healthcare and require improvement. Both groups suggested that an integrated specialist diabetes-kidney service could improve care. Unit heads emphasised the importance of quality improvement activities.ConclusionsGPs and tertiary health-care professionals emphasised the importance of patient self-management and primary care involvement in the health-care of diabetes and CKD. Supporting GPs with an accessible, multidisciplinary diabetes-renal health service underpinned by strong communication pathways, a preventive approach and quality improvement activities, may improve health-care and patient outcomes in co-morbid diabetes and CKD.

【 授权许可】

CC BY   
© Lo et al. 2016