Lo Clement, Ilic Dragan, Teede Helena, Cass Alan, Fulcher Greg, Gallagher Martin, Johnson Greg, Kerr Peter G, Mathew Tim, Murphy Kerry, Polkinghorne Kevan, Walker Rowan, Zoungas Sophia
Diabetes and Vascular Research Program, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia.
PLoS One. 2016 Jan 5;11(1):e0146615. doi: 10.1371/journal.pone.0146615. eCollection 2016.
Multi-morbidity due to diabetes and chronic kidney disease (CKD) remains challenging for current health-systems, which focus on single diseases. As a first step toward health-care improvement, we explored the perspectives of patients and their carers on factors influencing the health-care of those with co-morbid diabetes and CKD.
In this qualitative study participants with co-morbid diabetes and CKD were purposively recruited using maximal variation sampling from 4 major tertiary health-services from 2 of Australia's largest cities. Separate focus groups were conducted for patients with CKD stages 3, 4 and 5. Findings were triangulated with semi-structured interviews of carers of patients. Discussions were transcribed verbatim and thematically analysed.
Twelve focus groups with 58 participants and 8 semi-structured interviews of carers were conducted. Factors influencing health-care of co-morbid diabetes and CKD grouped into patient and health service level factors. Key patient level factors identified were patient self-management, socio-economic situation, and adverse experiences related to co-morbid diabetes and CKD and its treatment. Key health service level factors were prevention and awareness of co-morbid diabetes and CKD, poor continuity and coordination of care, patient and carer empowerment, access and poor recognition of psychological co-morbidity. Health-service level factors varied according to CKD stage with poor continuity and coordination of care and patient and carer empowerment emphasized by participants with CKD stage 4 and 5, and access and poor recognition of psychological co-morbidity emphasised by participants with CKD stage 5 and carers.
According to patients and their carers the health-care of co-morbid diabetes and CKD may be improved via a preventive, patient-centred health-care model which promotes self-management and that has good access, continuity and coordination of care and identifies and manages psychological morbidity.
糖尿病和慢性肾脏病（CKD）导致的多种疾病并存，对当前专注于单一疾病的卫生系统而言，仍是一项挑战。作为改善医疗保健的第一步，我们探讨了患者及其护理人员对影响糖尿病和CKD并存患者医疗保健因素的看法。
在这项定性研究中，采用最大差异抽样法，从澳大利亚两个最大城市的4家主要三级医疗服务机构中，有目的地招募了糖尿病和CKD并存的参与者。对CKD 3、4和5期的患者分别进行了焦点小组讨论。通过对患者护理人员的半结构化访谈，对研究结果进行了三角验证。讨论内容逐字记录并进行了主题分析。
共进行了12个焦点小组讨论，有58名参与者，对护理人员进行了8次半结构化访谈。影响糖尿病和CKD并存患者医疗保健的因素分为患者层面因素和卫生服务层面因素。确定的关键患者层面因素包括患者自我管理、社会经济状况，以及与糖尿病和CKD并存及其治疗相关的不良经历。关键卫生服务层面因素包括对糖尿病和CKD并存的预防和认知、护理的连续性和协调性差、患者及护理人员的赋权、心理共病的可及性及认知不足。卫生服务层面因素因CKD分期而异，CKD 4期和5期的参与者强调护理的连续性和协调性差以及患者及护理人员的赋权，而CKD 5期的参与者和护理人员则强调心理共病的可及性及认知不足。
根据患者及其护理人员的说法，通过一种预防性的、以患者为中心的医疗保健模式，可以改善糖尿病和CKD并存患者的医疗保健，该模式促进自我管理，具有良好的可及性、连续性和护理协调性，并能识别和管理心理疾病。
