Department of General Practice and Primary Health Care, Ghent University, Belgium.
BMC Fam Pract. 2011 Sep 8;12:94. doi: 10.1186/1471-2296-12-94.
Self-management support is seen as a cornerstone of good diabetes care and many countries are currently engaged in initiatives to integrate self-management support in primary care. Concerning the organisation of these programs, evidence is growing that engagement of health care professionals, in particular of GPs, is critical for successful application. This paper reports on a study exploring why a substantial number of GPs was (initially) reluctant to refer patients to a self-management education program in Belgium.
Qualitative analysis of semi-structured face-to-face interviews with a purposive sample of 20 GPs who were not regular users of the service. The Greenhalgh diffusion of innovation framework was used as background and organising framework.
Several barriers, linked to different components of the Greenhalgh model, emerged from the interview data. One of the most striking ones was the limited readiness for innovation among GPs. Feelings of fear of further fragmentation of diabetes care and frustration and insecurity regarding their own role in diabetes care prevented them from engaging in the innovation process. GPs needed time to be reassured that the program respects their role and has an added value to usual care. Once GPs considered referring patients, it was not clear enough which of their patients would benefit from the program. Some GPs expressed the need for training in motivational skills, so that they could better motivate their patients to participate. A practical but often mentioned barrier was the distance to the centre where the program was delivered. Further, uncertainty about continuity interfered with the uptake of the offer.
The study results contribute to a better understanding of the reasons why GPs hesitate to refer patients to a self-management education program. First of all, the role of GPs and other health care providers in diabetes care needs to be clarified before introducing new functions. Feelings of security and a basic trust of providers in the health system are a prerequisite for participation in care innovation. Moreover, some important lessons regarding the implementation of an education program in primary care have been learned from the study.
自我管理支持被视为良好糖尿病护理的基石，许多国家目前都在开展将自我管理支持纳入初级保健的计划。关于这些计划的组织，越来越多的证据表明，卫生保健专业人员的参与，特别是全科医生的参与，对于成功应用至关重要。本文报告了一项研究，该研究探讨了为什么相当数量的全科医生最初不愿意将患者转介到比利时的自我管理教育计划中。
对 20 名未定期使用该服务的全科医生进行了有针对性的半结构化面对面访谈，对访谈数据进行了定性分析。采用 Greenhalgh 创新扩散框架作为背景和组织框架。
访谈数据中出现了几个与 Greenhalgh 模型不同组成部分相关的障碍。最引人注目的障碍之一是全科医生对创新的准备不足。他们对糖尿病护理进一步碎片化的恐惧、对自己在糖尿病护理中的角色的沮丧和不安全感，阻碍了他们参与创新过程。全科医生需要时间来确保该计划尊重他们的角色，并为常规护理增加价值。一旦全科医生考虑转介患者，就不清楚哪些患者会从该计划中受益。一些全科医生表示需要接受动机技能培训，以便更好地激励患者参与。一个实际但经常提到的障碍是距离提供该计划的中心的距离。此外，对连续性的不确定性也影响了该计划的推广。
研究结果有助于更好地理解全科医生为什么犹豫将患者转介到自我管理教育计划中。首先，在引入新功能之前，需要明确全科医生和其他卫生保健提供者在糖尿病护理中的角色。提供者对卫生系统的安全感和基本信任是参与护理创新的前提。此外，从该研究中吸取了一些关于在初级保健中实施教育计划的重要经验教训。
