Table 3 Practice-reported barriers to care for patients with diabetes
From: Socializing the evidence for diabetes control to develop “mindlines”: a qualitative pilot study
| Barrier | Details |
|---|---|
| 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 |