“我有时只能给他们提供药物”：在泰米尔纳德邦为残疾人提供初级糖尿病护理的挑战。

"Medicines is all that I can sometimes offer them": challenges of providing primary diabetes care to persons with disabilities in Tamil Nadu.

机构信息

Centre for Applied Research, The Gandhigram Rural Institute - Deemed to be University, Dindigul District, Tamil Nadu, 624 302, Gandhigram, India.

Research, Monitoring and Evaluation Lead, Resource Group for Education and Advocacy for Community Health (REACH), Chennai, India.

出版信息

BMC Health Serv Res. 2022 Jul 5;22(1):861. doi: 10.1186/s12913-022-08246-1.

DOI:10.1186/s12913-022-08246-1

PMID:35790969

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9253259/

Abstract

BACKGROUND

Persons with disabilities have a higher risk for and poorer outcomes of type 2 diabetes. Primary health care providers face several challenges in providing primary diabetes care for them. This study was conducted to explore the challenges faced by primary health care providers in delivering primary diabetes services to persons with disabilities.

METHODS

We performed a qualitative research study by conducting in-depth interviews among 13 primary health care providers including medical officers, staff nurses, community health workers and a physiotherapist. We adopted a descriptive qualitative research approach to data collection and analysis.

RESULTS

Primary health care providers often could only prescribe medications to persons with diabetes by proxy due to poor accessibility of the facilities. They felt that these patients also had poor compliance to treatment. They felt that the lack of standard guidelines for diet and exercise for persons with disabilities prevented them from giving them appropriate advice on the same and even if they did, persons with disabilities would find it very difficult to adopt dietary changes and physical activity as they were dependent on others for even their daily activities. They also felt that they couldn't perform annual screening tests due to lack of accessibility to higher facilities. Some primary care providers did local innovations such as formation of peer support groups, utilization of resources of other programs to reach out to persons with disabilities and innovative physical activity techniques to care for persons with disabilities. They recommended that there is a need for specific guidelines for management of diabetes among persons with disabilities, treatment of chronic diseases among persons with disabilities must be incentivized and there must be intersectoral coordination between social welfare department and health department to achieve the goal of care for persons with disabilities.

CONCLUSIONS

Primary health care providers faced substantial challenges in providing primary diabetes care for persons with disabilities. There is a need for an effective public health policy to address these challenges.

摘要

背景

残疾人患 2 型糖尿病的风险更高，结局更差。基层医疗服务提供者在为他们提供初级糖尿病护理方面面临诸多挑战。本研究旨在探讨基层医疗服务提供者在为残疾人提供初级糖尿病服务方面面临的挑战。

方法

我们对包括医生、护士、社区卫生工作者和物理治疗师在内的 13 名基层医疗服务提供者进行了深入访谈，开展了一项定性研究。我们采用描述性定性研究方法进行数据收集和分析。

结果

由于设施通行不便，基层医疗服务提供者往往只能代残疾人开处方药。他们认为这些患者的治疗依从性也较差。他们认为，缺乏针对残疾人的饮食和运动标准指南，使他们无法就相关内容提供适当建议，即使他们提供了建议，残疾人也很难改变饮食和进行体育活动，因为他们的日常活动甚至都依赖他人。他们还认为，由于无法获得更高水平的设施，他们无法进行年度筛查测试。一些基层医疗服务提供者进行了当地创新，例如组建同伴支持小组、利用其他项目的资源为残疾人提供服务，以及创新体育活动技术以照顾残疾人。他们建议，需要为残疾人管理糖尿病制定具体指南，必须激励为残疾人治疗慢性病，并且社会福利部门和卫生部门之间必须进行跨部门协调，以实现残疾人护理目标。