Volume 1 number 1 Summer 2003
Special issue for the abstracts of the 7th Pan Arab Conference on Diabetes
PACD7 , 25 – 28 March 2003 Cairo

 Abstract Number : 8
Barriers and Facilitators to Care in the Management of Type 2 Diabetes Mellitus.

Hugh Alberti, UK

In order to improve quality of care, information is needed about the barriers and facilitators to care in the management of type 2 diabetes mellitus. The process of care of patients with diabetes is complex and yet crucial to millions of people around the world. Early work is being done in the Western world in determining factors that influence quality of care of patients with diabetes. Factors previously postulated as potential barriers or facilitators to care can be broadly separated into patient, clinician and organizational factors. Patient factors thought to influence the process of care can be physical, such as age, sex, length of illness and type of diabetes and treatment. Psychological and socio-economic factors are also thought to have an influence, as are attendance at health care clinics and concordance with treatment. Other work has suggested that cultural and religious background, language barriers and lack of education are also factors that influence diabetes care. Clinician and health professional factors identified are predominantly in the areas of training, education and knowledge of diabetes. However, studies have suggested that even with appropriate knowledge, clinicians do not always follow suggested guidelines and so other factors such as the clinicians' health beliefs and personality have been postulated. Doctor-patient communication may also be a factor.
Organizational factors previously described are often related to the local situation and thus are not transferable outside of one region. Possible transferable factors are the locality of clinics, use of guidelines within a structured care program, availability of treatment and resources at health care facilities. Many of these variables may be transferable globally but locally and culturally relevant factors would also be expected to be important. A small number of studies have looked at the process of diabetes care outside the Western world and their results incorporated into health care programs. To our knowledge, no studies have yet explored the barriers and facilitators to diabetes care in a North African setting. We have therefore commenced a study in Tunisia, using a combination of qualitative and quantitative methods, to explore the factors that influence the management of patients with type 2 diabetes mellitus. Early results have generated a large number of potential factors that may be of particular relevance to diabetes management in this area of the world and will be discussed.

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