RT Journal Article
SR Electronic
T1 Clinical care gaps and solutions in diabetes and advanced chronic kidney disease: a patient-oriented qualitative research study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E258
OP E263
DO 10.9778/cmajo.20180177
VO 7
IS 2
A1 Kristin K. Clemens
A1 Leah Getchell
A1 Tracy Robinson
A1 Bridget L. Ryan
A1 Jim O’Donnell
A1 Sonja M. Reichert
YR 2019
UL http://www.cmajopen.ca/content/7/2/E258.abstract
AB Background: Patients with diabetes and advanced chronic kidney disease face a high health care burden. As part of a patient-oriented research initiative to identify ways to better support patients’ diabetes care, we explored their health care experience and solutions for patient-centred diabetes care.Methods: We engaged 2 patients with advanced kidney disease and diabetes to join our multidisciplinary team as full research partners. They were involved in our design and conduct of the study, the analysis of the results and knowledge translation. We conducted qualitative interviews (1:1 semistructured interviews and focus groups) with patients with a history of both diabetes (type 1 or 2) and advanced kidney disease including those using dialysis. We identified overarching themes using individual and team analysis and conducted interviews until data saturation was reached.Results: Twelve participants were interviewed between October 2017 and February 2018. Six people were interviewed in 2 separate focus groups (consisting of 4 and 2 participants) and 6 participated in 1:1 interviews with our team. Participants described being burdened by medical appointments, strict conflicting diets, costly diabetes therapies and fragmented, siloed health care. They indicated that self-management support, education and coordinated diabetes care might better support their diabetes care.Interpretation: Patients with complex medical comorbidities face many challenges traversing a health care system organized around single diseases. Researchers and policy-makers should study and develop patient-centred diabetes care strategies to better support these high-risk patients.