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Open Access Highly Accessed Research article

Why do GPs hesitate to refer diabetes patients to a self-management education program: a qualitative study

Patricia Sunaert1*, Marie Vandekerckhove2, Hilde Bastiaens3, Luc Feyen1, Piet Vanden Bussche1, Jan De Maeseneer1, An De Sutter1 and Sara Willems1

Author Affiliations

1 Department of General Practice and Primary Health Care, Ghent University, Belgium

2 Department of Clinical & Lifespan Psychology & Experimental and Applied Psychology, Brussels University, Belgium

3 Department of General Practice, Interdisciplinary Healthcare and Geriatrics, Antwerp University, Belgium

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BMC Family Practice 2011, 12:94  doi:10.1186/1471-2296-12-94

Published: 8 September 2011

Abstract

Background

Self-management support is seen as a cornerstone of good diabetes care and many countries are currently engaged in initiatives to integrate self-management support in primary care. Concerning the organisation of these programs, evidence is growing that engagement of health care professionals, in particular of GPs, is critical for successful application. This paper reports on a study exploring why a substantial number of GPs was (initially) reluctant to refer patients to a self-management education program in Belgium.

Methods

Qualitative analysis of semi-structured face-to-face interviews with a purposive sample of 20 GPs who were not regular users of the service. The Greenhalgh diffusion of innovation framework was used as background and organising framework.

Results

Several barriers, linked to different components of the Greenhalgh model, emerged from the interview data. One of the most striking ones was the limited readiness for innovation among GPs. Feelings of fear of further fragmentation of diabetes care and frustration and insecurity regarding their own role in diabetes care prevented them from engaging in the innovation process. GPs needed time to be reassured that the program respects their role and has an added value to usual care. Once GPs considered referring patients, it was not clear enough which of their patients would benefit from the program. Some GPs expressed the need for training in motivational skills, so that they could better motivate their patients to participate. A practical but often mentioned barrier was the distance to the centre where the program was delivered. Further, uncertainty about continuity interfered with the uptake of the offer.

Conclusions

The study results contribute to a better understanding of the reasons why GPs hesitate to refer patients to a self-management education program. First of all, the role of GPs and other health care providers in diabetes care needs to be clarified before introducing new functions. Feelings of security and a basic trust of providers in the health system are a prerequisite for participation in care innovation. Moreover, some important lessons regarding the implementation of an education program in primary care have been learned from the study.