GPs' experienced challenges and strategies for supporting patient self-management in disease management programs for type 2 diabetes mellitus and coronary heart disease - a qualitative study.

BACKGROUND

Effective self-management (SM) is essential for improving health and preventing severe complications in patients with lifestyle-related chronic conditions, such as type 2 diabetes mellitus (T2DM) and CHD. Thus, enhancing patients' SM through self-management support has become an integral part of chronic care programs worldwide. However, information on the current focus on SM in German disease management programs (DMPs) is very limited. The aim of this study was to understand general practitioners' (GPs') experiences and strategies for promoting SM.

METHODS

An exploratory qualitative design was selected, resulting in the conduct of five focus group discussions with 20 GPs in August and September 2020. The GPs were recruited from the teaching practices of the University Hospital Cologne through purposive sampling. Their experiences and opinions on SM were assessed in questions blocks using a semi-structured interview guide and analysed by a multi-professional team employing Kuckartz' method of qualitative content analysis.

RESULTS

The focus group discussions were structured around three main categories: (1) GPs' perceived patient SM in the DMPs for T2DM and CHD, (2) GPs' perceptions of factors influencing patient motivation for SM, and (3) strategies fostering patient motivation for SM. Discussions revolved around patients' motivation and capabilities to implement a sustainable SM in their daily lives. Many GPs followed a patient-centered approach to foster SM in their patients, considering various challenging individual, social and institutional factors that influence SM in chronically ill patients.

CONCLUSION

GPs regularly support their patients' SM as a routine part of the DMP through ongoing consultations and education. However, they face several challenges in facilitating sustainable patient SM, which requires support by additional and standardized measures beyond the current DMP care to be effective.