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A Qualitative Assessment Of Educational Opportunities For Primary Care Providers In Type 2 Diabetes Care

K. Cytryn, W. Garvey, S. M. Hayes, Linda Cann, S. Murray
Published 2009 · Medicine

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The management of people diagnosed with diabetes increasingly challenges health care personnel in the United States. The number of people with diabetes increases by ~ 1 million yearly,1 and diabetes was the primary diagnosis in 23.8 million visits to office-based physicians in 2006, most commonly to general practitioners, family physicians, and internists.2 Managing diabetes requires practitioners to be competent in complexities of disease management as well as in patient communication, counseling, and education—understanding how multiple psychosocial factors affect patient care and outcomes. Primary care practitioners (PCPs) are therefore required to master both physiological and psychosocial approaches to treatment and management. Yet many are challenged in doing so.3 Although diabetes requires patients to accept a large role in self-management of their illness, examination of patients' and physicians' viewpoints revealed disparate viewpoints and experiences in approaches to treatment and psychosocial implications of managing and coping with the disease. Patients expressed frustration with practitioners' lack of understanding of their perspective, whereas health care practitioners expressed frustration with patients' inability to achieve objectives in health-behavior change and metabolic control.4,5 Although physicians acknowledged the importance of psychosocial issues and behavioral factors in diabetes management, their interaction and educational interventions with their patients centered primarily on disease, pathophysiology, and treatment regimens—an emphasis inconsistent with their patients' perceived needs.6 Comparison of patients' and providers' estimates of patient self-care activities revealed further discrepancies, with patients reporting higher levels of their own adherence to therapeutic regimens compared with reports of their providers.3 Programs targeting improvement in patient adherence are complex and can include multiple intensive components such as reminders, reinforcement, counseling, and family therapy.7 To further compound the disparity between needs of patients and actions of professionals, clinicians acknowledged that their patients had multiple physical and psychosocial obstacles to treatment …
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