title: Barriers to providing diabetes care in community health centers.
abstract: OBJECTIVE
  We aimed to identify barriers to improving care for individuals with diabetes in community health centers. These findings are important because many such patients, as in most other practice settings, receive care that does not meet evidence-based standards.
  
  
  METHODS
  In 42 Midwestern health centers, we surveyed 389 health providers and administrators about the barriers they faced delivering diabetes care. We report on home blood glucose monitoring, HbA1c tests, dilated eye examinations, foot examinations, diet, and exercise, all of which are a subset of the larger clinical practice recommendations of the American Diabetes Association (ADA).
  
  
  RESULTS
  Among the 279 (72%) respondents, providers perceived that patients were significantly less likely than providers to believe that key processes of care were important (overall mean on 30-point scale: providers 26.8, patients 18.2, P = 0.0001). Providers were more confident in their ability to instruct patients on diet and exercise than on their ability to help them make changes in these areas. Ratings of the importance of access to care and finances as barriers varied widely; however, >25% of the providers and administrators agreed that significant barriers included affordability of home blood glucose monitoring, HbA1c testing, dilated eye examination, and special diets; nonproximity of ophthalmologist; forgetting to order eye examinations and to examine patients' feet; time required to teach home blood glucose monitoring; and language or cultural barriers.
  
  
  CONCLUSIONS
  Providers in health centers indicate a need to enhance behavioral change in diabetic patients. In addition, better health care delivery systems and reforms that improve the affordability, accessibility, and efficiency of care are also likely to help health centers meet ADA standards of care.
authors.affiliation: Department of Medicine, Diabetes Research and Training Center,  University of Chicago, Illinois 60637, USA. mchin@medicine.bsd.uchicago.edu
authors.forename: M H
authors.initials: MH
authors.lastname: Chin
authors.forename: S
authors.initials: S
authors.lastname: Cook
authors.forename: L
authors.initials: L
authors.lastname: Jin
authors.forename: M L
authors.initials: ML
authors.lastname: Drum
authors.forename: J F
authors.initials: JF
authors.lastname: Harrison
authors.forename: J
authors.initials: J
authors.lastname: Koppert
authors.forename: F
authors.initials: F
authors.lastname: Thiel
authors.forename: A G
authors.initials: AG
authors.lastname: Harrand
authors.forename: C T
authors.initials: CT
authors.lastname: Schaefer
authors.forename: H T
authors.initials: HT
authors.lastname: Takashima
authors.forename: S C
authors.initials: SC
authors.lastname: Chiu
mesh_terms: D015190:Blood Glucose Self-Monitoring / Q000191:economics; D003151:Community Health Centers; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D017719:Diabetic Foot / Q000175:diagnosis; D003930:Diabetic Retinopathy / Q000175:diagnosis; D004032:Diet; D015444:Exercise; D006442:Glycated Hemoglobin / Q000032:analysis; D017048:Health Care Costs; D006297:Health Services Accessibility; D006801:Humans; D010353:Patient Education as Topic
chemical_list: D006442:Glycated Hemoglobin