Azam Laila, Meurer John, Nelson David, Asan Onur, Flynn Kathryn, Knudson Paul, Young Staci
Carroll University, Waukesha, Wisconsin,
Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin.
WMJ. 2018 Dec;117(5):219-223.
The aim of this study is to understand how the physician-patient relationship is related to referral practices for diabetes self-management education and physicians' perceptions of culturally competent health care delivery at a large health system affiliated with an academic medical center in a Midwestern city.
Sixteen physicians (6 family medicine, 6 internal medicine, 4 endocrinology) participated in semistructured interviews. Interviews were audio-recorded, transcribed, and coded. Data were thematically analyzed using MAXQDA software.
All physicians considered diabetes self-management education a very important part of diabetes treatment, but physician referral patterns to diabetes education varied. Study findings indicated that both high and low referring physicians reported providing care that was responsive to personalized patient needs, including cultural beliefs, attitudes, and behaviors that affect health/health care. Building relationships and rapport with patients led to discussions of understanding barriers to diabetes management.
This study highlights physicians' perceptions of and concerns about referrals to diabetes self-management education and the treatment of type 2 diabetes. Physicians understood the personal, environmental, and health care factors that limit the number of racial/ethnic minorities from participating.
In addition to diabetes education, physicians suggested that additional resources or programs will help them address socioeconomic factors beyond their control and to understand cultural preferences.
本研究旨在了解在中西部城市一所与学术医疗中心相关的大型医疗系统中，医患关系如何与糖尿病自我管理教育的转诊实践以及医生对具有文化胜任力的医疗服务的认知相关。
16名医生（6名家庭医学医生、6名内科医生、4名内分泌科医生）参与了半结构化访谈。访谈进行了录音、转录和编码。使用MAXQDA软件对数据进行了主题分析。
所有医生都认为糖尿病自我管理教育是糖尿病治疗的一个非常重要的部分，但医生向糖尿病教育的转诊模式各不相同。研究结果表明，转诊率高和低的医生都报告称提供了符合患者个性化需求的护理，包括影响健康/医疗保健的文化信仰、态度和行为。与患者建立关系和融洽的氛围会引发对理解糖尿病管理障碍的讨论。
本研究突出了医生对糖尿病自我管理教育转诊以及2型糖尿病治疗的认知和担忧。医生了解限制少数种族/族裔参与人数的个人、环境和医疗保健因素。
除了糖尿病教育外，医生们建议，额外的资源或项目将帮助他们解决超出其控制范围的社会经济因素，并了解文化偏好。
