Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/119493
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Type: | Journal article |
Title: | Gaps and barriers in health-care provision for co-morbid diabetes and chronic kidney disease: a cross-sectional study |
Author: | Lo, C. Teede, H. Fulcher, G. Gallagher, M. Kerr, P.G. Ranasinha, S. Russell, G. Walker, R. Zoungas, S. |
Citation: | BMC Nephrology, 2017; 18(1):80-80 |
Publisher: | © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
Issue Date: | 2017 |
ISSN: | 1471-2369 1471-2369 |
Statement of Responsibility: | C. Lo, H. Teede, G. Fulcher, M. Gallagher, P. G. Kerr, S. Ranasinha, G. Russell, R. Walker and S. Zoungas |
Abstract: | Patients with diabetes and chronic kidney disease (CKD) are a complex subset of the growing number of patients with diabetes, due to multi-morbidity. Gaps between recommended and received care for diabetes and chronic kidney disease (CKD) are evident despite promulgation of guidelines. Here, we document gaps in tertiary health-care, and the commonest patient-reported barriers to health-care, before exploring the association between these gaps and barriers.This cross-sectional study recruited patients with diabetes and CKD (eGFR < 60 mL/min/1.73 m2) across 4 large hospitals. For each patient, questionnaires were completed examining clinical data, recommended care, and patient-reported barriers limiting health-care. Descriptive statistics, subgroup analyses by CKD stage and hospital, and analyses examining the relationship between health-care gaps and barriers were performed.308 patients, of mean age 66.9 (SD 11.0) years, and mostly male (69.5%) and having type 2 diabetes (88.0%), participated. 49.1% had stage 3, 24.7% stage 4 and 26.3% stage 5 CKD. Gaps between recommended versus received care were evident: 31.9% of patients had an HbA1c ≥ 8%, and 39.3% had a measured blood pressure ≥ 140/90 mmHg. The commonest barriers were poor continuity of care (49.3%), inadequate understanding/education about CKD (43.5%), and feeling unwell (42.6%). However, barriers associated with a failure to receive items of recommended care were inadequate support from family and friends, conflicting advice from and poor communication amongst specialists, the effect of co-morbidities on self-management and feeling unmotivated (all p < 0.05).Barriers to health-care varied across CKD stages and hospitals. Barriers associated with a deviation from recommended care were different for different items of care, suggesting that specific interventions targeting each item of care are required. |
Keywords: | Diabetes; chronic kidney disease; multi-morbidity; health-care; tertiary health-care; treatment gaps; barriers |
Rights: | © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
DOI: | 10.1186/s12882-017-0493-x |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1055175 |
Published version: | http://dx.doi.org/10.1186/s12882-017-0493-x |
Appears in Collections: | Aurora harvest 4 Medicine publications |
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File | Description | Size | Format | |
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hdl_119493.pdf | Published Version | 1.97 MB | Adobe PDF | View/Open |
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