Brown Judith Belle, Harris Stewart B, Webster-Bogaert Susan, Wetmore Stephen, Faulds Catherine, Stewart Moira
Centre for Studies in Family Medicine, Department of Family Medicine, The University of Western Ontario, 100 Collip Circle, London, Ontario N6G 4X8, Canada.
Fam Pract. 2002 Aug;19(4):344-9. doi: 10.1093/fampra/19.4.344.
Few studies have explored the contextual dimensions and subsequent interactions that contribute to a lack of adherence in the application of guidelines for diabetes management.
The purpose of this qualitative study was to explore family physicians' issues and perceptions regarding the barriers to and facilitators of the management of patients with type 2 diabetes mellitus (DM).
Four focus groups composed of family physicians (n= 30) explored the participants' experiences in the management of patients with type 2 DM. A semi-structured interview guide began with questions on family physicians' experience of providing care and included specific probes to stimulate discussion about the various barriers to and facilitators of the management of type 2 DM in family practice.
Participants clearly identified type 2 DM as a chronic disease most often managed by family physicians. The findings revealed distinct barriers and facilitators in managing patients with type 2 DM which fell into three domains: patient factors; physician factors; and systemic factors. There was a dynamic interplay among the three factors. The important role of education was common to each.
The interactions of patient, physician and systemic factors have implications for the implementation of a diabetes management model. The care of patients with type 2 DM exemplifies the ongoing challenges of caring for patients with a chronic disease in family practice. The findings, while specific to the management of type 2 DM, have potential transferability to other chronic illnesses managed by family physicians.
很少有研究探讨导致糖尿病管理指南应用中依从性不足的背景因素及后续相互作用。
本定性研究旨在探讨家庭医生在2型糖尿病（DM）患者管理方面面临的问题以及对障碍和促进因素的看法。
由家庭医生组成的四个焦点小组（n = 30）探讨了参与者在2型糖尿病患者管理方面的经验。一份半结构化访谈指南以关于家庭医生提供护理经验的问题开始，并包括特定的探究问题，以激发关于家庭医疗中2型糖尿病管理的各种障碍和促进因素的讨论。
参与者明确将2型糖尿病视为家庭医生最常管理的慢性病。研究结果揭示了在管理2型糖尿病患者方面存在明显的障碍和促进因素，可分为三个领域：患者因素；医生因素；和系统因素。这三个因素之间存在动态相互作用。教育的重要作用在每个领域都很常见。
患者、医生和系统因素的相互作用对糖尿病管理模式的实施具有影响。2型糖尿病患者的护理体现了家庭医疗中照顾慢性病患者持续存在的挑战。这些发现虽然特定于2型糖尿病的管理，但有可能适用于家庭医生管理的其他慢性病。
