Study Examines Perceived Barriers to Care for At-Risk Patients with Diabetes

A new study shows that primary care physicians believe the barriers that put patients with uncontrolled diabetes at risk for cardiovascular disease as being patient-related or system-related. Published online by the Journal of the American Board of Family Medicine by researchers at UMDNJ-Robert Wood Johnson Medical School and colleagues at the University of Hawaii and University of Michigan, the research reports that the physician participants commonly found a high level of frustration at being unable to motivate patients with poor control or help patients to overcome the barriers that inhibit healthier lifestyles.

“Physicians inherently want to help their patients get better, but diabetes is a chronic disorder that becomes more difficult to manage over time, even when treated properly,” lead study author Jesse Crosson, PhD, assistant professor of family medicine and director of the New Jersey Primary Care Research Network at UMDNJ-Robert Wood Johnson Medical School, said in a news release. “Our study is the first step in identifying ways to help primary care providers assist their patients in overcoming obstacles and developing strategies to help relieve the frustration felt by providers.”

The study interviewed 34 primary care physicians in diverse practices in California, Indiana, Michigan and New Jersey who provided outpatient care to adult diabetic patients. Many of the physicians responded that patient-related socioeconomic concerns proved to be a significant barrier to maintaining good diabetic health. This included financial struggles that kept patients from maintaining the challenging lifestyle and diet that diabetes requires. Family-related concerns, such as a lack of support or caring for other family members before themselves, also proved a significant barrier for patients. The study also found that other medical conditions, such as pain or depression competed with patients’ efforts to control cardiovascular risk factors.

System-related barriers fell into two categories: the physician’s ability to deliver care and the patient’s ability to access care. Physicians identified the cost of transportation to get to appointments, and the high cost of medication to treat diabetes as significant barriers for their patients. The health system presented other barriers such as difficulties obtaining referrals and making convenient appointments.

System-related barriers preventing physicians from delivering care included the failure to utilize technology to make a patient’s health record readily accessible at the point of care. Poor coordination of care among health care providers also was noted as a significant barrier.

Physicians’ perceptions that they were unable to help patients overcome these barriers resulted in high levels of frustration. According to the study, this response was consistent among physicians in all four areas of the country included in the study. The frustration arose from a perceived inability to address patients’ motivation for maintaining good health, patients’ resistance to treatment recommendations and a belief that the barriers faced by patients are outside of physicians’ control.

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