title: Barriers associated with poor control in Spanish diabetic patients. A consensus study.
abstract: BACKGROUND
  Delphi technique allows developing a multidisciplinary consensus to establish solutions.
  
  
  OBJECTIVE
  To identify barriers and solutions to improve control in patients with Type-2 Diabetes Mellitus (DM2).
  
  
  METHODS
  An observational study using the 2-round Delphi technique (June-August 2011). A panel of 108 experts in DM2 from medical and nursing fields (primary care providers and specialists) from different regions completed via email a questionnaire with 41 Likert statements and 9 scores for each one. Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the two groups (Kappa index and McNemar chi-square).
  
  
  RESULTS
  Response rate: 65%. Degree of agreement: 63.4% (95% CI 48.7-78.1%) in medicine, and 78.1% (95% CI 65.4-90.8) in nursing (p > 0.05). Overall level of agreement: Kappa = 0.43, (χ(2) = 2.5 p > 0.05). Regarding non-compliance with therapy, it improves with: the information to the partner/family/caregiver, patient education degree in diabetes, patient motivation and ability to share and agree on decisions with the patient. Clinical inertia improves with: motivation degree of healthcare professionals and the calculation of cardiovascular risk; and gets worse with: the shortage of time in consultation, absence of data in medical record, border high limits measurements accepted as normal readings, lack of a treatment goals, lack of teamwork (Physician/Nurse), scarcity of resources and lack of alarm systems in the electronic medical record on goals to achieve.
  
  
  CONCLUSIONS
  The participants achieved an agreement in interventions in non-therapeutic compliance and clinical inertia to improve DM2 control.
authors.affiliation: Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain. atencion.primaria@umh.es
authors.forename: M C
authors.initials: MC
authors.lastname: Carratalá-Munuera
authors.forename: V F
authors.initials: VF
authors.lastname: Gil-Guillen
authors.forename: D
authors.initials: D
authors.lastname: Orozco-Beltran
authors.forename: J
authors.initials: J
authors.lastname: Navarro-Pérez
authors.forename: F
authors.initials: F
authors.lastname: Caballero-Martínez
authors.forename: F
authors.initials: F
authors.lastname: Alvarez-Guisasola
authors.forename: J
authors.initials: J
authors.lastname: García-Soidán
authors.forename: C
authors.initials: C
authors.lastname: Fluixá-Carrascosa
authors.forename: J
authors.initials: J
authors.lastname: Franch-Nadal
authors.forename: E
authors.initials: E
authors.lastname: Martín-Rioboó
authors.forename: L
authors.initials: L
authors.lastname: Carrillo-Fernández
authors.forename: S
authors.initials: S
authors.lastname: Artola-Menéndez
mesh_terms: D001291:Attitude of Health Personnel; D032921:Consensus; D003697:Delphi Technique; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055118:Medication Adherence; D011364:Professional Practice / Q000592:standards*; D013030:Spain; D011795:Surveys and Questionnaires; D017211:Treatment Failure