Quality of interaction between primary health-care providers and patients with type 2 diabetes in Muscat, Oman

University dissertation from Stockholm : Karolinska Institutet, Department of Public Health Sciences

Abstract: Objectives: This study aimed at exploring the quality of interactions between health-care providers and type 2 diabetic patients at primary health-care level in Muscat, Oman, focusing on the consultation environment, care and information, and how the patients perceived these interactions. Methods: Two cross-sectional sub-studies were performed using quantitative and qualitative research methods. Data for the first sub-study was collected through direct observations of 90 consultations with 23 doctors and 85 consultations with 13 diabetes nurses in six primary health-care centres (PHCCs), using checklists developed from the National Diabetes Guidelines and other studies on patient-provider interaction. Consultations were assessed as optimal if more than 75% of observed aspects were fulfilled, sub-optimal if less than 50% were fulfilled and intermediate if the level of fulfilments was 50-75%. Data for the second sub-study was collected through focus group discussions (FGDs) among women and men with type 2 diabetes, attending the PHCCs. Qualitative content analysis was applied. Main findings: In 48% of the consultations there was an optimal environment, care and information. The score of fulfillment was lower for shorter consultations. Overall scoring of the individual doctors’ consultations showed that only ten doctors were optimal in their interactions with the patients, both creating a positive consultation environment and providing optimal care and information. The quality of the diabetes nurses’ interactions was sub-optimal in about 75% of their consultations. Some important aspects of positive interactions were poorly fulfilled by doctors and nurses such as: consultation privacy; encouraging the patients to ask questions; attention; emphasis on patients understanding of the provided information; and inquiry about adverse effects of medicine and risky habits, like smoking or alcohol consumption. There was a low referral to health educators or dieticians, and the diabetes nurses provided health education for a few patients. The combined scores of all aspects for both doctors and diabetes nurses showed that they interacted optimally with the patients in only one health centre. Participants of FGDs identified several weaknesses with regard to patient-provider communication such as: unfriendly welcoming, interruption of privacy and poor attention. Moreover, the patients expressed their inability to participate in the medical dialogue or express concerns, and they discussed other problems and difficulties related to a patient-centred approach. Furthermore, some patients perceived the doctors and nurses neither to be experts, nor as competent enough in diabetes care. In addition, the patients were dissatisfied with issues related to the organization of the diabetes clinics and access to care such as: long waiting time; lack of care continuity and poor health education. Conclusions and recommendations: The interactions of the doctors and diabetes nurses with type 2 diabetes patients were not optimal in relation to the national guidelines and there was poor collaboration between the diabetes team members. Furthermore, the patients’ were to a great extent dissatisfied with the services at PHCCs in Muscat. The role of diabetes nurses, dieticians and health educators should be enhanced. Better utility of the resources and patients’ awareness of these resources within the practice could be achieved through a multidisciplinary team approach and training of the providers to upgrade their skills regarding communication and care with emphasis on patientcentred care and empowerment approach. Barriers to compliance with the guidelines need to be further explored. The results of this study can serve as a point of departure for the policy makers in Oman and countries with similar health systems, for improving the quality of diabetes care, and for further improvement in the organizational efficiency of diabetes services.

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