Preprint / Version 1

Managing diabetes mellitus with comorbidities in primary healthcare facilities in urban settings: a qualitative study among physicians in Odisha, India

Authors

  • Sandipana Pati Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
  • Sanghamitra Pati Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha India
  • Marjan Akker Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
  • F Schellevis Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers Location VUmc, Amsterdam, Netherlands
  • Krushna Sahoo Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha India
  • Jako Burgers Department of Family Medicine, School CAPRI, Maastricht University, Maastricht, the Netherlands

Keywords:

Diabetes mellitus, Comorbidity, Primary care physicians

Abstract

Aim To explore the perceived barriers and facilitators in the management of the patients having diabetes with comorbidities by primary care physicians. Methods A qualitative In-Depth Interview study was conducted among the primary care physicians at seventeen urban primary health care centres at Bhubaneswar city of Odisha, India. The digitally recorded interviews were transcribed verbatim and translated into English. The data were analysed using thematic analysis. Results Barriers related to physicians, patients and health system were identified. Physicians felt lack of necessary knowledge and skills, communication skills and overburdening due to multiple responsibilities to be major barriers to quality care. Patients’ attitude and beliefs along with socio-economic status played an important role in treatment adherence and in the management of their disease conditions. Poor infrastructure, irregular medicine supply, and shortage of skilled allied health professionals were also found to be barriers to optimal care delivery, as was the lack of electronic medical records and personal treatment records. Conclusion Comprehensive guidelines with on the job training for capacity building of the physicians and creation of multidisciplinary teams at primary care level for a more holistic approach towards management of diabetes with comorbidities could be the way forward to optimal delivery of care. Keywords: Diabetes mellitus, Comorbidity, Primary care physicians

Author Biographies

Sandipana Pati, Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India

Indian Institute of Public Health Bhubaneswar (PHFI), Plot No. 267/3408, Jaydev Vihar, Mayfair Lagoon Road, Bhubaneswar-751013, Bhubaneswar, Odisha India

Marjan Akker, Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt am Main, Germany

Academic Centre of General Practice, KU Leuven, Leuven, Belgium

F Schellevis, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers Location VUmc, Amsterdam, Netherlands

NIVEL (Netherlands Institute for Health Services Research, Utrecht, the Netherlands

Jako Burgers, Department of Family Medicine, School CAPRI, Maastricht University, Maastricht, the Netherlands

Dutch College of General Practitioners, Utrecht, The Netherlands

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