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The burden of treatment in people living with type 2 diabetes: A qualitative study of patients and their primary care clinicians.
Espinoza, Pilar; Varela, Camila A; Vargas, Ivonne E; Ortega, Galo; Silva, Paulo A; Boehmer, Kasey B; Montori, Victor M.
Afiliação
  • Espinoza P; School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile.
  • Varela CA; Mental Community Health Center Pedro Aguirre Cerda, Santiago, Chile.
  • Vargas IE; School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile.
  • Ortega G; Andes Family Health Center, Santiago, Chile.
  • Silva PA; School of Nutrition, Universidad San Sebastian, Santiago, Chile.
  • Boehmer KB; Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, New York, United States of America.
  • Montori VM; Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, New York, United States of America.
PLoS One ; 15(10): e0241485, 2020.
Article em En | MEDLINE | ID: mdl-33125426
BACKGROUND: The burden of treatment can overwhelm people living with type 2 diabetes and lead to poor treatment fidelity and outcomes. Chronic care programs must consider and mitigate the burden of treatment while supporting patients in achieving their goals. OBJECTIVE: To explore what patients with type 2 diabetes and their health providers consider are the workload and the resources they must mobilize, i.e., their capacity, to shoulder it. METHODS: We conducted focus groups comprised of 30 patients and 32 clinicians from three community health centers in Chile implementing the Chronic Care Model to reduce cardiovascular risk in patients with type 2 diabetes. Transcripts were analyzed using thematic content analysis techniques illuminated by the Minimally Disruptive Medicine framework. FINDINGS: Gaining access to and working with their clinicians, implementing complex medication regimens, and changing lifestyles burdened patients. To deal with the distress of the diagnosis, difficulties achieving disease control, and fear of complications, patients drew capacity from their family (mostly men), social environment (mostly women), lay expertise, and spirituality. Clinicians found that administrative tasks, limited formulary, and protocol rigidity hindered their ability to modify care plans to reduce patient workload and support their capacity. CONCLUSIONS: Chronic primary care programs burden patients living with type 2 diabetes while hindering clinicians' ability to reduce treatment workloads or support patient capacity. A collaborative approach toward Minimally Disruptive Medicine may result in treatments that fit the lives and loves of patients and improve outcomes.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diabetes Mellitus Tipo 2 Tipo de estudo: Guideline / Prognostic_studies / Qualitative_research Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Chile Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Chile País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diabetes Mellitus Tipo 2 Tipo de estudo: Guideline / Prognostic_studies / Qualitative_research Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Chile Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Chile País de publicação: Estados Unidos