title: Why do GPs hesitate to refer diabetes patients to a self-management education program: a qualitative study.
abstract: BACKGROUND
  Self-management support is seen as a cornerstone of good diabetes care and many countries are currently engaged in initiatives to integrate self-management support in primary care. Concerning the organisation of these programs, evidence is growing that engagement of health care professionals, in particular of GPs, is critical for successful application. This paper reports on a study exploring why a substantial number of GPs was (initially) reluctant to refer patients to a self-management education program in Belgium.
  
  
  METHODS
  Qualitative analysis of semi-structured face-to-face interviews with a purposive sample of 20 GPs who were not regular users of the service. The Greenhalgh diffusion of innovation framework was used as background and organising framework.
  
  
  RESULTS
  Several barriers, linked to different components of the Greenhalgh model, emerged from the interview data. One of the most striking ones was the limited readiness for innovation among GPs. Feelings of fear of further fragmentation of diabetes care and frustration and insecurity regarding their own role in diabetes care prevented them from engaging in the innovation process. GPs needed time to be reassured that the program respects their role and has an added value to usual care. Once GPs considered referring patients, it was not clear enough which of their patients would benefit from the program. Some GPs expressed the need for training in motivational skills, so that they could better motivate their patients to participate. A practical but often mentioned barrier was the distance to the centre where the program was delivered. Further, uncertainty about continuity interfered with the uptake of the offer.
  
  
  CONCLUSIONS
  The study results contribute to a better understanding of the reasons why GPs hesitate to refer patients to a self-management education program. First of all, the role of GPs and other health care providers in diabetes care needs to be clarified before introducing new functions. Feelings of security and a basic trust of providers in the health system are a prerequisite for participation in care innovation. Moreover, some important lessons regarding the implementation of an education program in primary care have been learned from the study.
authors: Department of General Practice and Primary Health Care, Ghent University, Belgium. patricia.sunaert@ugent.be
authors: Patricia
authors: P
authors: Sunaert
authors: Marie
authors: M
authors: Vandekerckhove
authors: Hilde
authors: H
authors: Bastiaens
authors: Luc
authors: L
authors: Feyen
authors: Piet Vanden
authors: PV
authors: Bussche
authors: Jan
authors: J
authors: De Maeseneer
authors: An
authors: A
authors: De Sutter
authors: Sara
authors: S
authors: Willems
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001530:Belgium; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D005260:Female; D058005:General Practitioners / Q000523:psychology* / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012648:Self Care / Q000379:methods* / Q000523:psychology; D013997:Time Factors; D016526:Workload