Barriers to care in patients with diabetes and poor glycemic control-A cross-sectional survey

• Published in: PloS one Vol. 12; no. 5; p. e0176135
• Main Authors: McBrien, Kerry A, Naugler, Christopher, Ivers, Noah, Weaver, Robert G, Campbell, David, Desveaux, Laura, Hemmelgarn, Brenda R, Edwards, Alun L, Saad, Nathalie, Nicholas, David, Manns, Braden J
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.05.2017; Public Library of Science (PLoS)
• Subjects: Adhesion; Adults; Aged; Aged, 80 and over; Alberta - epidemiology; Analysis; Bass; Binary data; Biology and life sciences; Biomarkers - blood; Cancer; Cardiovascular diseases; Catchments; Collection; Communities; Complications; Cross-Sectional Studies; Data acquisition; Data collection; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - epidemiology; Diabetes therapy; Diagnosis; Diet; Disease management; Disorders; Drugs; Endocrinology; Engineering and Technology; Epidemiology; Ethics; Female; Financial management; Food; Food security; Glucose; Glycated Hemoglobin - metabolism; Glycemic index; Health care; Health care access; Health care services accessibility; Health risks; Health Services Accessibility; Heart; Heart diseases; Hemoglobin; Humans; Hypoglycemic Agents - therapeutic use; Income; Indicators; Insulin; Insurance, Pharmaceutical Services; Interviews as Topic; Male; Measurement; Medical personnel; Medicine; Medicine and health sciences; Mental disorders; Metabolic disorders; Metabolism; Microvasculature; Middle Aged; Morbidity; Myocardial infarction; Nursing; Nutrition; On-line systems; Patient outcomes; Patients; People and Places; Population studies; Public health; Risk reduction; Self Care; Self Report; Social Sciences; Social Support; Software; Therapy; Ontario Canada; Canada; Calgary Alberta Canada
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0176135

To determine and quantify the prevalence of patient, provider and system level barriers to achieving diabetes care goals; and to examine whether barriers were different for people with poor glycemic control (HbA1c ≥ 10%; 86 mmol/mol) compared to fair glycemic control (7 to <8%; 53-64 mmol/mol). We administered a survey by telephone to community-dwelling patients with diabetes, to examine patient-reported barriers and facilitators to care. We compared responses in individuals with HbA1c ≥ 10% (86 mmol/mol) against those with HbA1c between 7-8% (53-64 mmol/mol). We examined associations between HbA1c group and barriers to care, adjusting for sociodemographic factors and diabetes duration. The survey included 805 people with HbA1c ≥ 10% (86 mmol/mol), and 405 people with HbA1c 7-8% (53-64 mmol/mol). Participants with HbA1c ≥ 10% (86 mmol/mol) reported good access to care, however 20% of participants with HbA1c ≥ 10% (86 mmol/mol) felt that their care was not well-coordinated and 9.6% reported having an unmet health care need. In adjusted analysis, patients with HbA1c ≥10% (86 mmol/mol) were more likely to report lack of confidence and inadequate social support, compared to patients with HbA1c 7-8% (53-64 mmol/mol). They were also significantly more likely not to have drug insurance nor to have received recommended treatments because of cost. These results reinforce the importance of an individualized, yet multi-faceted approach. Specific attention to financial barriers seems warranted. These findings can inform the development of programs and initiatives to overcome barriers to care, and improve diabetes care and outcomes.