Fhärm Eva, Rolandsson Olov, Johansson Eva E
Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Fam Pract. 2009 Apr;26(2):109-14. doi: 10.1093/fampra/cmp002. Epub 2009 Feb 10.
Studies have revealed low adherence to guidelines for treatment of diabetes and cardiovascular risk factors.
To explore GPs' experiences regarding treatment practice in type 2 diabetes with specific focus on the prevention of cardiovascular disease.
Fourteen experienced GPs from nine health care centres with group practices were interviewed in focus groups. The interviews were digitally recorded, transcribed verbatim and analysed by qualitative content analysis.
The overall theme was 'dilemmas' in GPs' treatment practice for type 2 diabetes patients. Five main dilemma categories were identified. First, the GPs were hesitant about labelling someone who feels healthy as ill. Second, regarding communicating a diabetes diagnosis and its consequences; should the patient be frightened or comforted? Third, the GPs experienced uncertainty in their role; were they to take responsibility for the care or not? Fourth, the GPs expressed a conflict between lifestyle changes and drug treatment. Fifth, the GPs described difficulties in integrating science into reality.
The five dilemmas in the GPs' approach to diabetes patients and the treatment of their cardiovascular risk were related to the GPs' professional role and communication with the patient. To consider these dilemmas in educational efforts is probably essential to achieve improved diabetes care and guideline adherence.
研究显示，糖尿病及心血管危险因素的治疗指南依从性较低。
探讨全科医生在2型糖尿病治疗实践中的经验，尤其关注心血管疾病的预防。
来自9个集体执业医疗中心的14名经验丰富的全科医生参与了焦点小组访谈。访谈进行了数字录音，逐字转录，并采用定性内容分析法进行分析。
总体主题是全科医生在2型糖尿病患者治疗实践中的“困境”。确定了五个主要困境类别。第一，全科医生对于将感觉健康的人标记为患病有所犹豫。第二，在传达糖尿病诊断及其后果方面；应该吓唬患者还是安慰患者？第三，全科医生在其角色方面存在不确定性；他们是否应该负责护理？第四，全科医生表示在生活方式改变和药物治疗之间存在冲突。第五，全科医生描述了将科学融入实际的困难。
全科医生在治疗糖尿病患者及其心血管危险因素时面临的五个困境与全科医生的专业角色以及与患者的沟通有关。在教育工作中考虑这些困境可能对于改善糖尿病护理和指南依从性至关重要。
