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Barriers associated with poor control in Spanish diabetic patients. A consensus study

Authors


  • Disclosures

    Carratalá-Munuera M. C has no potential conflicts to declare in relation to this paper. Gil-Guillen VF has no potential conflicts to declare in relation to this paper. Orozco-Beltran D received payment for Advisory board or lectures from MSD, Eli Lilly Company, Novo-Nordisk and Sanofi-Aventis in the last year. Navarro-Pérez J has no potential conflicts to declare in relation to this paper. Caballero-Martínez F: none declared. Álvarez-Guisasola F received payment for Advisory board or lectures from Eli Lilly Company, Novo-Nordisk, Merck & Co, Bristol-Myers-Squibb-AstraZeneca and Sanofi-Aventis in the last year. García-Soidán J has no potential conflicts to declare in relation to this paper. Fluixá-Carrascosa C: None declared. Franch-Nadal J: none declared. Martín-Rioboó E received honoraria for Advisory board or for giving talks for MSD, in the last year; received honoraria from AstraZeneca, MSD, Boheringer-Ingleheim and BAYER, for lectures or for giving talks in scientific congress and work-shop in the last year. Carrillo-Fernández L has no potential conflicts to declare in relation to this paper. Artola-Menéndez S has no conflicts of interest in the writing of this article.

Correspondence to:

M. C. Carratala Munuera,

Campus Universitario de San Juan. Crta de Valencia N-332,

Km 87 03550 San Juan (Alicante), Spain

Tel.: +96 591 9309

Fax: +96 591 9450

Email: atencion.primaria@umh.es

Summary

Background

Delphi technique allows developing a multidisciplinary consensus to establish solutions.

Aim

To identify barriers and solutions to improve control in patients with Type-2 Diabetes Mellitus (DM2).

Methods

An observational study using the 2-round Delphi technique (June–August 2011). A panel of 108 experts in DM2 from medical and nursing fields (primary care providers and specialists) from different regions completed via email a questionnaire with 41 Likert statements and 9 scores for each one. Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the two groups (Kappa index and McNemar chi-square).

Results

Response rate: 65%. Degree of agreement: 63.4% (95% CI 48.7–78.1%) in medicine, and 78.1% (95% CI 65.4–90.8) in nursing (p > 0.05). Overall level of agreement: Kappa = 0.43, (χ2 = 2.5 p > 0.05). Regarding non-compliance with therapy, it improves with: the information to the partner/family/caregiver, patient education degree in diabetes, patient motivation and ability to share and agree on decisions with the patient. Clinical inertia improves with: motivation degree of healthcare professionals and the calculation of cardiovascular risk; and gets worse with: the shortage of time in consultation, absence of data in medical record, border high limits measurements accepted as normal readings, lack of a treatment goals, lack of teamwork (Physician/Nurse), scarcity of resources and lack of alarm systems in the electronic medical record on goals to achieve.

Conclusion

The participants achieved an agreement in interventions in non-therapeutic compliance and clinical inertia to improve DM2 control.

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