Project Purpose Statement
The purpose of this project is to identify barriers to improving care for individuals with diabetes in community primary care clinics. The findings from this research will be important in ensuring diabetic patients receive care that meets evidence-based standards as in other practice settings.
Background and Significance
The global burden of diabetes has continuously increased over the past decades making prevention and effective treatment crucial to its management. Despite the advancement in diagnosis and treatment of this condition, persistent inadequate glucose control remains a challenge (Adu et al., 2019). One of the key factors contributing to the increased challenge of poor control of blood sugar is the existence of barriers to diabetes management. For example, the expansion of markets for unhealthy commodities due to globalization continues to expose many individuals to unhealthy lifestyles that promote the development of diabetes. The majority of the affected individuals live in low and middle-income neighborhoods where access to these commodities is easy. In 2019, it was estimated that 463 million individuals had diabetes worldwide and four-fifths of them lived in low-and middle-income countries (Blasco-Blasco et al., 2020). The combination of these factors with others like lack of healthcare access makes it difficult to control diabetes.
Effective management of diabetes is multifactorial and involves coordination between patients, healthcare providers, and healthcare systems. Patients depend on healthcare providers and the healthcare system to receive appropriate treatment and health education regarding diabetes care. These patients also have a crucial role in diabetes self-management through actions like dietary modification, exercise, and routine blood glucose monitoring (Kutz et al., 2019). A breakdown in the three relationships means that barriers will exist in ensuring patients access the required healthcare services to control diabetes. For example, the lack of enough resources in primary care clinics can make it difficult to diagnose diabetes and manage complications. Issues like lack of adequate capital can make it impossible for affected individuals to afford treatment and maintain a proper diet.
The management of diabetes does not only depend on the treatment of the disease, but also prevention of its impact on society. Many countries have developed universal health insurance programs that are mainly observed to deal with rehabilitation and treatment (Lin et al., 2020). Important aspects like prevention of the disease and addressing the phases of diagnosis appropriately have been left out. Strengthening the primary care system for improved secondary and tertiary management of the disease is imperative to the control of diabetes across all countries. Primary healthcare centers need to look beyond the treatment of the disease and apply evidence-based strategies to reach those individuals that are at risk (Lin et al., 2020). However, challenges remain in the effective implementation of the required standards of care due to the existence of certain barriers.
Previous studies investigating the barriers to diabetes management have mainly focused on individual behaviors rather than considering the patient’s environment (Blasco-Blasco et al., 2020). Well, it is not surprising that researchers focus on what the patient can do because diabetes is a lifestyle disease that majorly develops due to problems with individuals. Perhaps, healthcare systems can be blamed for ineffective care when patients develop complications like retinopathies and neuropathies that can be prevented through adequate glycemic control (Adu et al., 2019). Emerging evidence indicates that interactions between access and the use of healthcare/sociocultural environments greatly influence diabetes control (Blasco-Blasco et al., 2020). There should be a shift from focusing on individual barriers to diabetes management to what healthcare systems have failed to do for effective treatment of the disease.
Access to healthcare is a complex concept that affects most individuals with chronic conditions like diabetes (Cu et al., 2021). Facilitating access involves helping people to command appropriate healthcare resources to improve their health. Access to healthcare is one area that has been investigated and observed to influence the care of diabetic patients, especially the elderly. This concept goes beyond the physical availability of the healthcare system and proximity to the affected individual to involve the availability of required services in those facilities (Cu et al., 2021). For example, healthcare centers can be within the reach of patients but may not have enough healthcare workers or drugs for the treatment of patients. If services are available and there is an adequate supply of services, there exists an opportunity for patients to receive the intended care to manage their conditions. While evaluating the barriers to effective treatment of diabetes, the aspect of access should be thoroughly assessed to ascertain the readiness of primary care clinics to handle diabetic patients.
While preventive care practices and blood sugar control can prevent complications of diabetes, optimal care for this population depends on access to healthcare. The first aspect that has caused problems for most patients in rural communities is proximity to healthcare centers (McBrien et al., 2017). The frequency of healthcare use for diabetes patients is high because of regular blood sugar monitoring and treatment making barriers to access a hindrance to effective management. Researchers have also explored the issue of health insurance and effective blood sugar control. Uninsured people with diabetes are less likely to receive adequate care in primary care centers compared to their insured counterparts (Karachaliou et al., 2020). Additionally, those with inadequate coverage may find it difficult to receive the appropriate care and only afford basic treatment with cheap drugs. The elderly with vascular complications are more likely to receive poor treatment due to insurance issues and this further discourages their health visits to the healthcare centers (McBrien et al., 2017). Access to healthcare should be among the first areas to be addressed to ensure receipt of preventive healthcare services to individuals with diabetes.
Safe cost-effective interventions for diabetes care are available to reduce the risk of vascular complications and deterioration of the patient’s condition (Karachaliou et al., 2020). Although most healthcare institutions have implemented these newer approaches, the reception of the care is low because of certain barriers. For example, only 50% of diabetes patients have access to certain programs like statin therapy which is shown to reduce vascular complications (McBrien et al., 2017). Patients with diabetes are burdened with complex treatment regimens that also contribute to the poor seeking of healthcare services. Although healthcare systems must ensure patients are aware of these strategies, issues of compliance are purely dependent on the affected individual. Putting aside factors like the cost of healthcare, researchers recommend that patients should make decisions about when and how to receive medical care (McBrien et al., 2017). Overall, a comprehensive understanding of the patient, provider, and system barriers is needed to inform patients on the right decisions to make when challenged with diabetes.
Diabetes self-management is essential to the control and prevention of the disease. Successful management of the condition requires patients to adhere to recommended practices, failure to which deterioration of their conditions fastens. Self-management requires individuals to follow certain programs like nutrition, physical activity, self-medication, and maintaining foot care guidelines (Adhikari et l., 20121). While these practices can look simple, performing them daily is challenging and patients exhibit barriers in fulfilling the required self-care. The most frequently observed barrier to self-management is a lack of education or knowledge on self-care, particularly those in rural communities (Adhikari et l., 20121). Other factors like difficulty adjusting to the new lifestyle, lack of culturally relevant knowledge, and communication barriers with healthcare providers can make it difficult to manage the disease. Healthcare providers must use appropriate communication strategies and other resources to ensure such patients can manage the disease. Addressing the communication gap between healthcare providers, healthcare systems, and patients can improve self-care practices to effectively manage the disease.
Identifying and addressing barriers present in healthcare systems can greatly influence the treatment of patients with diabetes. These gaps make it difficult for patients to receive the required healthcare services leading to poor glycemic control and management of complications. Poor glycemic control as the key indicator of diabetes control is reflected by both the failure in diabetes self-management and inadequate interventions by clinicians. This research will identify how primary care providers utilize available technologies like electronic health records to manage diabetes and technological barriers that can be addressed to improve diabetes care. This research will provide insight on factors outside the patient’s control that are observed to hinder their treatment and strategies that can be used to improve them. Through the identification of these barriers, this research intends to improve the aspect of healthcare access for diabetes patients and reduce complications that arise as a result of poor treatment.
PICOT Formatted Clinical Project Question
Among patients with diabetes (P), what is the effectiveness of identifying barriers to treatment in primary care clinics (I), compared to identifying barriers to self management (C), in achieving diabetes control (O) within 6 months?
Adhikari, M., Devkota, H. R., & Cesuroglu, T. (2021). Barriers to and facilitators of diabetes self-management practices in Rupandehi, Nepal-multiple stakeholders’ perspective. BMC Public Health, 21(1), 1-18. https://doi.org/10.1186/s12889-021-11308-4
Adu, M. D., Malabu, U. H., Malau-Aduli, A., & Malau-Aduli, B. S. (2019). Enablers and barriers to effective diabetes self-management: A multi-national investigation. PloS One, 14(6), e0217771. https://doi.org/10.1371/journal.pone.0217771
Blasco-Blasco, M., Puig-García, M., Piay, N., Lumbreras, B., Hernández-Aguado, I., & Parker, L. A. (2020). Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review. PloS One, 15(9), e0237542. https://doi.org/10.1371/journal.pone.0237542
Cu, A., Meister, S., Lefebvre, B., & Ridde, V. (2021). Assessing healthcare access using the Levesque’s conceptual framework–A scoping review. International Journal for Equity in Health, 20(1), 1-14. https://doi.org/10.1186/s12939-021-01416-3
Karachaliou, F., Simatos, G., & Simatou, A. (2020). The challenges in the development of diabetes prevention and care models in low-income settings. Frontiers in Endocrinology, 11, 518. https://doi.org/10.3389/fendo.2020.00518
Kutz, T. L., Roszhart, J. M., Hale, M., Dolan, V., Suchomski, G., & Jaeger, C. (2018). Improving comprehensive care for patients with diabetes. BMJ Open Quality, 7(4), e000101. http://dx.doi.org/10.1136/bmjoq-2017-000101
Lin, X., Xu, Y., Pan, X., Xu, J., Ding, Y., Sun, X., … & Shan, P. F. (2020). Global, regional, and national burden and trend of diabetes in 195 countries and territories: An analysis from 1990 to 2025. Scientific Reports, 10(1), 1-11. https://doi.org/10.1038/s41598-020-71908-9
McBrien, K. A., Naugler, C., Ivers, N., Weaver, R. G., Campbell, D., Desveaux, L., … & Manns, B. J. (2017). Barriers to care in patients with diabetes and poor glycemic control—A cross-sectional survey. PLoS One, 12(5), e0176135. https://doi.org/10.1371/journal.pone.0176135
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