Diabetes care in India: Physician practices and perspectives Open Access

Abstract

Abstract

Diabetes care in India: Physician practices and perspectives

By Seema D Shah

Aims: To describe physicians' practice characteristics, services and views on diabetes care in India in context of the Chronic Care Model and Innovative Care for Chronic Conditions Framework.

Methods: 160 physicians attending a national diabetes conference in India in 2009 responded to an anonymous, self-administered paper survey regarding their clinic characteristics, diabetes management resources, clinical targets and patient performance, and barriers and needs for optimal diabetes care.

Results: The sample of predominantly male, urban private-practice specialists reported that providing optimal care is challenging in a resource- and time-constrained setting with high patient loads. Diabetes cases represent half of the physicians' patients, with an age range of 31-60 years, who are largely homemakers or have sedentary jobs. Proper patient follow-up and self-management education are lacking. Conferences, journals, internet, and the pharmaceutical industry are major education sources. Although 77% of physicians report using standardized guidelines, roughly 50% of patients are meeting the targets. At a clinic level, integration of electronic record-keeping (60% are paper only), decision-support, and more non-physician staff are areas of need. At the community level, improving public awareness and access to affordable medications and services are major issues.

Conclusion: Physicians in India are aware of the patient, healthcare organization and community/policy level issues that are resulting in sub-optimal quality of diabetes care. Research associations and training institutions, in collaboration with other sectors and the public, have the capacity and opportunity to provide access to quality resources and training to improve diabetes care delivery, advocate for regional and national quality assurance and capacity-building, and raise public awareness.

Table of Contents

TABLE OF CONTENTS

Page Chapter 1: Introduction 1 Terms 7 Chapter 2: Literature Review 10 Chapter 3: Methods 22 References 26

Full Article (with tables and figure)

Table 1: Physician demographics and clinic and patient characteristics

Table 2: Physician IT use, record system, education and research

Table 3: Physician use of patient clinical targets compared to ADA 2009 guidelines and reported proportion of patients meeting designated targets

Table 4: Physician-reported barriers for optimal diabetes care and areas for improvement categorized according to Chronic Care Model elements

Figure 1: Innovative Care for Chronic Conditions framework

33 Appendix A: Questionnaire 61

Listing of Figures and Tables

Figure 1: Chronic Care Model 4

Figure 2: Innovative Care for Chronic Conditions framework

4

Table 1: Comparison of American Diabetes Association (2009) and Indian Council of Medical Research (2005) targets for risk factor control and processes of diabetes care

14

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	quality of care Innovative Care for Chronic Conditions framework diabetes Chronic Care Model India
Committee Chair / Thesis Advisor	Escoffery, Ngoc-Cam, Emory University
Committee Members	Venkat Narayan, K M, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs US (Federal) agency other than CDC International Non-governmental organization (e.g., CARE, Inc.)

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