Discordance in Perceptions of Barriers to Diabetes Care Between Patients and Primary Care and Secondary Care

Abstract

OBJECTIVE—We sought to compare perceived barriers to diabetes care between people with diabetes and different health professional groups. RESEARCH DESIGN AND METHODS—This was a cross-sectional, postal, open-questionnaire survey conducted in the Waikato district, New Zealand. A total of 3,890 individuals with diabetes participated, as well as 436 primary and secondary health professionals. RESULTS—Barriers were reported in 69.7% of patients. Psychological barriers were most important (55.5%), followed by systems barriers (25.7%), and then knowledge as least important (15.3%). Psychological barriers were ranked first among general practitioners (91.0%), but systems barriers were ranked first by other health professionals (38.8–100%). General practitioner and patient barrier group rankings were similar (rT = 0.976, P < 0.05). Of specific barriers among individuals with diabetes, strictness of treatment regimen was the most frequently reported (42.3 vs. 0.1–16.8%) (P < 0.001) and 2.5 (95% CI 2.4–2.7)- to 3.4 (3.2–3.7)-fold more than the 2nd through 4th ranked barriers. Motivation was the most common specific barrier reported by general practitioners (86%), practice nurses (31.5%), and the diabetes team (85.7%). Practice and hospital nurse/dietitian rankings were most comparable with patients (rT = 0.457 and 0.466, respectively, both P < 0.05). A major area of patient–health professional discordance was the influence of other health problems, which was ranked 2nd among patients but 10th–18th among health professionals. CONCLUSIONS—The most important barriers to diabetes care perceived by patients are psychological and particularly relate to the strictness of the regimen. Discordance between patients and different health professionals exists in the perception of the importance of different barriers to diabetes care.