Multidisciplinary coordinated care for Type 2 diabetes: A qualitative analysis of patient perspectives

Highlights

• Coordinated, multidisciplinary diabetes team care is acceptable to patients.

• Team care did not detract from the patient-primary care relationship.

• Ideal team care would include support for exercise and socioeconomic challenges.

Abstract

Aims

To explore the patient perspective on coordinated multidisciplinary diabetes team care among a socioeconomically diverse group of adults with type 2 diabetes.

Methods

Qualitative research design using 8 focus groups (n = 53). We randomly sampled primary care patients with type 2 diabetes and conducted focus groups at their primary care clinic. Discussion prompts queried current perceptions of team care. Each focus group was audio recorded, transcribed verbatim, and independently coded by three reviewers. Coding used an iterative process. Thematic saturation was achieved. Data were analyzed using content analysis.

Results

Most participants believed that coordinated multidisciplinary diabetes team care was a good approach, feeling that diabetes was too complicated for any one care team member to manage. Primary care physicians were seen as too busy to manage diabetes alone, and participants were content to be treated by other care team members, especially if there was a single point of contact and the care was coordinated. Participants suggested that an ideal multidisciplinary approach would additionally include support for exercise and managing socioeconomic challenges, components perceived to be missing from the existing approach to diabetes care.

Conclusions

Coordinated, multidisciplinary diabetes team care is understood by and acceptable to patients with type 2 diabetes.

Introduction

Optimal diabetes care is interdisciplinary and complex. For example, even a patient with well-controlled diabetes might regularly see a physician, a diabetes nurse educator, and a dietitian just for direct diabetes management. To address difficult-to-control diabetes, or prevent or manage diabetes complications, the number of providers expands considerably: endocrinologists, ophthalmologists, and podiatrists might all be a regular part of some individuals’ care. When possible, team provision of comprehensive diabetes care is the recommended approach, ideally as part of the patient-centered medical home, with team members working at the top of their license [1], [2]. This differs from prior care models, in which the individual doctor–patient relationship was the paramount, and often the sole, relationship.

Very little is known regarding the patient experience of care in the relatively new team care model, and important questions remain unanswered: do patients feel that care is coordinated or fragmented [3]? Do patients feel deprived of time with individual providers [4]? Do patients see themselves as part of the team, or, as one recent study of interprofessional team meetings found, might some feel that “They are talking about me, but not with me” [5]? Further, patient perceptions of care quality may diverge from other quality assessments used in healthcare [6].

Our academic medical center implemented a diabetes team care model within 20 primary care practices that were part of our practice-based research network between 2012 and 2014 [7]. The model shifted the focus of diabetes care from a model that centered on the doctor–patient relationship with referrals to certified diabetes educators and dietitians as needed, to one that emphasized more protocolized, multidisciplinary care involving practice-based nurses and dietitians, embedded locally in clinics [7]. An evaluation of the model found significant improvement in glycemic control for patients with hemoglobin A1c >9.0% [7]. In this project, we sought to understand the patient experience of diabetes care and patient perspective on team care, as well as to determine preferences for the provision of ideal diabetes care, both to shape the model and to identify any potential pitfalls of this approach. Specifically, our goal was to obtain patient perspectives that could drive implementation of patient-centered diabetes care in the primary care setting.