| Patient-level barriers | Provider-level barriers | System-level barriers |
|---|---|---|
| Time Not enough time to see family physician | Time Not enough time to spend with patients to explain what is needed; not enough time spent specifically managing a patient’s diabetes; given limited time, it is hard to decide what diabetes issues to focus on | Human resources Shortage of primary care physicians; need more allied health care workers within primary care network |
| Motivation Difficult to stay motivated over time, affects adherence | Human resources Insufficient access to other disciplines (e.g., nurses, pharmacists) | Lack of a navigation guide Lack of connectivity, including which types of patients need to go where; need to better market available resources to patients and health care providers |
| Cost Cost of adhering to medication and testing strips | Communication Lack of/poor communication and conflicting messages between specialists | Legal Legal responsibility with respect to working with allied health workers |
| Psychological issues/depression Need to treat depression and other psychological issues first | Knowledge — guidelines What guidelines are current? How to deal with conflicting guidelines? Where to find current guidelines? Navigating voluminous, non–user-friendly guidelines | Other Redundancy across programs offered by AHS and primary care networks Unstable financial environment (not knowing if the primary care network budget will continue and for how long) Wait time to see specialists can be too long Better team management — hard to manage a patient alone as a physician |
| Will Lack of willingness to deal with “bigger lifestyle” problems (v. taking medication) | Knowledge — other: Specialists disagree about patient management Physicians receive inadequate training in leading an interprofessional team Inability to help patients access AHS resources | |
| Resources Cannot always find resources Difficult to navigate the system |
Note: AHS = Alberta Health Services. *Barriers were identified through patient survey and from the focus group of health care providers.