Barriers to care in patients with diabetes and poor glycemic control-A cross-sectional survey.

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2017
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Abstract
To determine and quantify the prevalence of patient, provider and system level barriers to achieving diabetes care goals; and to examine whether barriers were different for people with poor glycemic control (HbA1c ≥ 10%; 86 mmol/mol) compared to fair glycemic control (7 to <8%; 53-64 mmol/mol).We administered a survey by telephone to community-dwelling patients with diabetes, to examine patient-reported barriers and facilitators to care. We compared responses in individuals with HbA1c ≥ 10% (86 mmol/mol) against those with HbA1c between 7-8% (53-64 mmol/mol). We examined associations between HbA1c group and barriers to care, adjusting for sociodemographic factors and diabetes duration.The survey included 805 people with HbA1c ≥ 10% (86 mmol/mol), and 405 people with HbA1c 7-8% (53-64 mmol/mol). Participants with HbA1c ≥ 10% (86 mmol/mol) reported good access to care, however 20% of participants with HbA1c ≥ 10% (86 mmol/mol) felt that their care was not well-coordinated and 9.6% reported having an unmet health care need. In adjusted analysis, patients with HbA1c ≥10% (86 mmol/mol) were more likely to report lack of confidence and inadequate social support, compared to patients with HbA1c 7-8% (53-64 mmol/mol). They were also significantly more likely not to have drug insurance nor to have received recommended treatments because of cost.These results reinforce the importance of an individualized, yet multi-faceted approach. Specific attention to financial barriers seems warranted. These findings can inform the development of programs and initiatives to overcome barriers to care, and improve diabetes care and outcomes.
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mcbrien2017barriersplos Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors McBrien, Kerry A;Naugler, Christopher;Ivers, Noah;Weaver, Robert G;Campbell, David;Desveaux, Laura;Hemmelgarn, Brenda R;Edwards, Alun L;Saad, Nathalie;Nicholas, David;Manns, Braden J;
Journal PloS one
Year 2017
DOI
10.1371/journal.pone.0176135
URL
Keywords
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