title: Multidisciplinary care: experience of patients with complex needs.
abstract: The rapidly increasing prevalence of diabetes with its high morbidity and mortality raises the need for an integrated multidisciplinary service from health care providers across health sectors. The aim of this study was to explore the diabetic patients' experience of multidisciplinary care, in particular their perceptions, perceived barriers and facilitators. Thirteen patients with type-2 diabetes admitted to the emergency department of a local hospital in NSW were interviewed and completed a demographic questionnaire. Results showed that patients found it inconvenient to be referred to many health professionals because of multiple physical and psychosocial barriers. Separate sets of instructions from different health professionals were overwhelming, confusing and conflicting. Lack of a dedicated coordinator of care, follow up and support for self-management from health professionals were factors that contributed to patients' challenges in being actively involved in their care. The presence of multiple co-morbidities made it more difficult for patients to juggle priorities and 'commitments' to many health professionals. In addition, complex socioeconomic and cultural issues, such as financial difficulties, lack of transport and language barriers, intensified the challenge for these patients to navigate the health system independently. Few patients felt that having many health professionals involved in their care improved their diabetes control. Communication among the multidisciplinary care team was fragmented and had a negative effect on the coordination of care. The patients' perspective is important to identify the problems they experience and to formulate strategies for improving multidisciplinary care for patients with diabetes.
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia.
authors.forename: Della
authors.initials: D
authors.lastname: Maneze
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dennis
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia.
authors.forename: Huei-Yang
authors.initials: HY
authors.lastname: Chen
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Taggart
authors.affiliation: South Western Sydney Local Health District General Practice Unit, PO Box 5, Fairfield, NSW 1860, Australia.
authors.forename: Sanjyot
authors.initials: S
authors.lastname: Vagholkar
authors.affiliation: South Western Sydney Local Health District General Practice Unit, PO Box 5, Fairfield, NSW 1860, Australia.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Bunker
authors.affiliation: South Western Sydney Local Health District General Practice Unit, PO Box 5, Fairfield, NSW 1860, Australia.
authors.forename: Siaw Teng
authors.initials: ST
authors.lastname: Liaw
mesh_terms: D001294:Attitude to Health; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D006297:Health Services Accessibility; D006801:Humans; D007400:Interprofessional Relations; D009517:New South Wales; D010348:Patient Care Team; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires