Table 3 Practice-reported barriers to care for patients with diabetes

Patient factors

Patient does not follow through with referral (have to make their own appointments)

Patients are reluctant to change medications

Non-compliant patients who “should not be on our metric list”

Patient’s agenda is different than the quality agenda

Patients do not trust people on the phone (issue with telephonic care coordination support)

Patient desire for one-stop shopping – they are not going to come back to the office multiple times

Our patients are sicker, more disadvantaged, etc

Lack of transportation

Context Factors

Patient load

Care coordinators are not on site any longer

Lack of reliable information transfer between institutions

Practice staff too lean (especially nursing)

Lack of access to medication samples

Difficulty being an outlying clinic (“away from mothership,” “outcast”)

Short visit times/crowded agendas

Lack of RN (Registered Nurse) time for insulin teaching

Quality agenda overrides other patient-centered care

Resources

Inability to refer poorly controlled patients to endocrinology

Lack of nutrition referrals

Community resources insufficient

Cost

Medication costs, lack of coverage for non-insulin options

Clinicians do not always know costs