Background and Aims:
Diabetes is the commonest cause of chronic kidney disease (CKD). When combined, both conditions increase morbidity and mortality. Despite this, health care of patients with diabetes and CKD is often sub-optimal. In this qualitative study we explore how health care can be improved by examining key processes in patients’ management.
Materials and Methods:
Health professionals from 4 hospitals in Melbourne and Sydney were purposively sampled. Thirty-six participants were recruited into 6 focus groups. Maximal variation sampling ensured representation of endocrine, renal and allied health professionals. Eight Diabetes and Renal unit heads completed semi-structured interviews to triangulate findings. Discussions were conducted until data saturation was reached and were transcribed verbatim. Data analysis was completed independently by 2 researchers using an inductive, thematic approach.
All participants agreed on the following key features that were perceived to influence the management of diabetes and CKD: 1) Patient involvement in health-care; 2) Patient access to health-care; 3) Communication between health care providers and between health-care providers and patients; 4) Coordination and integration of care including between primary and tertiary health care; and 5) Health services having a preventive and early intervention approach. Unit heads also described the importance of quality and improvement measures within a health service. Disparity in opinions between health professionals and unit heads were evident regarding the accessibility of tertiary health services and communication between health professionals; with unit heads of the belief that services were highly accessible to patients and that communication between staff was not a barrier.
The management of patients with diabetes and CKD is an interplay between hospital and community health-care and patient involvement in health-care. An ideal model of care requires an easily accessible, well-integrated, multidisciplinary hospital and community health service underpinned by strong communication and referral pathways, and quality assurance/improvement activities. This, together with good health professional-patient communication may empower patients and ultimately improve the outcomes of patients with diabetes and CKD.