Zhongguo quanke yixue (Jan 2024)
Barriers in Monitoring and Management of Chronic Kidney Disease in Type 2 Diabetes Based on the Perspective of General Practitioners: a Qualitative Research
Abstract
Background The prevalence rate of type 2 diabetes is increasing in China. General practitioners play an important role in the prevention and treatment of type 2 diabetes and its complications. Chronic kidney disease (CKD) is a common co-existing disease in patients with diabetes. However, at present, there is little research evidence on type 2 diabetes combined with CKD in primary care in China. Objective To investigate the obstructive factors in the monitoring and management of type 2 diabetes mellitus with CKD from the perspective of general practitioners. Methods From May to July 2022, a one-to-half structured interview was conducted with snowball sampling among general practitioners in an urban area of Beijing, and the interview outline was formulated based on the theoretical domains framework (TDF). NVivo 11 software was used to encode and classify the interview contents. Subject frame analysis method was used to sort out and analyze the data, and extract the theme. Results 13 general practitioners were interviewed in this study, and the years of working in general practice ranged from 8 to 22 years. The study identified barriers related to six domains in TDF, namely knowledge/skills, beliefs about outcomes, motivation and goals, medical background, resources and norms of conduct. After refining again, the themes were lack of systematic knowledge and skills related to CKD, imperfect incentive mechanism of primary medical staff, lack of smooth referral process between primary medical institutions and higher hospitals, poor self-management ability of patients and other obstacles. Conclusion There are many factors preventing general practitioners from monitoring and managing patients with type 2 diabetes complicated with CKD in the community. It is necessary to strengthen the knowledge and skills training of general practitioners with diabetes mellitus complicated with CKD, improve the ability of general practitioners to monitor and manage CKD, improve the incentive mechanism of primary medical institutions and establish an effective referral process with superior hospitals, strengthen the health education of patients, improve the self-management ability of patients, and enhance the prevention and treatment ability of primary medical institutions with type 2 diabetes complicated with CKD.
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