title: GPs' perspectives of type 2 diabetes patients' adherence to treatment: A qualitative analysis of barriers and solutions.
abstract: BACKGROUND
  The problem of poor compliance/adherence to prescribed treatments is very complex. Health professionals are rarely being asked how they handle the patient's (poor) therapy compliance/adherence. In this study, we examine explicitly the physicians' expectations of their diabetes patients' compliance/adherence. The objectives of our study were: (1) to elicit problems physicians encounter with type 2 diabetes patients' adherence to treatment recommendations; (2) to search for solutions and (3) to discover escape mechanisms in case of frustration.
  
  
  METHODS
  In a descriptive qualitative study, we explored the thoughts and feelings of general practitioners (GPs) on patients' compliance/adherence. Forty interested GPs could be recruited for focus group participation. Five open ended questions were derived on the one hand from a similar qualitative study on compliance/adherence in patients living with type 2 diabetes and on the other hand from the results of a comprehensive review of recent literature on compliance/adherence. A well-trained diabetes nurse guided the GPs through the focus group sessions while an observer was attentive for non-verbal communication and interactions between participants. All focus groups were audio taped and transcribed for content analysis. Two researchers independently performed the initial coding. A first draft with results was sent to all participants for agreement on content and comprehensiveness.
  
  
  RESULTS
  General practitioners experience problems with the patient's deficient knowledge and the fact they minimize the consequences of having and living with diabetes. It appears that great confidence in modern medical science does not stimulate many changes in life style. Doctors tend to be frustrated because their patients do not achieve the common Evidence Based Medicine (EBM) objectives, i.e. on health behavior and metabolic control. Relevant solutions, derived from qualitative studies, for better compliance/adherence seem to be communication, tailored and shared care. GPs felt that a structured consultation and follow-up in a multidisciplinary team might help to increase compliance/adherence. It was recognized that the GP's efforts do not always meet the patients' health expectations. This initiates GPs' frustration and leads to a paternalistic attitude, which may induce anxiety in the patient. GPs often assume that the best methods to increase compliance/adherence are shocking the patients, putting pressure on them and threatening to refer them to hospital.
  
  
  CONCLUSIONS
  GPs identified a number of problems with compliance/adherence and suggested solutions to improve it. GPs need communication skills to cope with patients' expectations and evidence based goals in a tailored approach to diabetes care.
authors.affiliation: Department of Family Practice, University of Antwerp - Faculty of Medicine, Universiteitsplein 1, 2610 Wilrijk (Antwerpen), Belgium. johan.wens@ua.ac.be.
authors.forename: Johan
authors.initials: J
authors.lastname: Wens
authors.forename: Etienne
authors.initials: E
authors.lastname: Vermeire
authors.forename: Paul Van
authors.initials: PV
authors.lastname: Royen
authors.forename: Bernard
authors.initials: B
authors.lastname: Sabbe
authors.forename: Joke
authors.initials: J
authors.lastname: Denekens
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001530:Belgium; D003142:Communication; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods*; D011340:Problem Solving; D036301:Qualitative Research; D011795:Surveys and Questionnaires