Background and Aims:
Diabetes and chronic kidney disease (CKD) commonly co-exist, contributing to significant morbidity and mortality. However, health-care in this group remains challenging in primary care. In this qualitative study we explore barriers, enablers and possible improvements to health-care.
We sought to recruit a representative sample of general practitioners (GPs) working in the health regions of 4 major hospitals in Australia’s 2 largest cities. Respondents to a widely distributed letter of invitation attended single focus groups in each region. The same experienced facilitator led each group. Discussions were transcribed verbatim. Data analysis was completed independently by 2 researchers, using an inductive, thematic approach.
Twenty-two GPs participated (20 male and 2 female) in 4 focus groups. The following prevalent themes emerged as barriers to optimal diabetes and CKD management: 1) Patient factors impacting involvement in health-care such as motivation, psychosocial and economic factors, 2) Lack of a preventative approach to health-care at GP and public health levels, 3) Poor access to specialist care (long waiting times for review, and lack of specialist phone advice) 4) Poor communication between GPs and specialists and 5) Poor coordination of care, with poor role definition between health professionals. Overall, GPs were of the view that the GP-patient relationship was central to patient health-care, with input from specialist health-care. Many GPs expressed the need to be included in the health-care of patients with advanced kidney disease requiring renal replacement therapy whilst some GPs reported specialist services as being dismissive of the role that GPs play in the health-care of such patients.
General practitioners want to be actively engaged in the care of patients with diabetes and chronic kidney disease, with greater role clarity. Improvements could include greater access to specialist care, better coordination, collaboration and communication between specialists and general practitioners, and a greater preventative approach.