title: In search of patient-centred care in middle income countries: the experience of diabetes care in the former Soviet Union.
abstract: In this study we apply the principles of patient-centred care to assess how health systems in middle income countries shape the experiences of patients with a common chronic disease and their care providers. We conducted semi-structured interviews with patients with diabetes, health professionals and key informants. We selected interviewees by purposive and snowball sampling. In total 340 respondents were interviewed in five countries: Armenia, Belarus, Moldova, Russia and Ukraine. Data were analysed according to a coding framework that was developed by three researchers, who then uncovered salient themes, similarities and differences between the five countries. Access to and consistent use of services was hampered by the lack of coordination and the financial weaknesses in the health systems. In many cases, lack of external support for individual patients left friends and family as the main providers of support. Patients were not expected to have a say or challenge the decisions concerning their treatment. Our study suggests the need for a radically different way of delivering care for people with diabetes and, by extension, other chronic diseases. Reforms should focus on improving self-management, the coordination of care, involving patients in decisions about their care, and providing emotional and practical support for patients.
authors.affiliation: London School of Hygiene and Tropical Medicine, European Centre on Health of Societies in Transition, 14-17 Tavistock Place, London WC1 9SH, United Kingdom. Electronic address: charlotte.kuhlbrandt@lshtm.ac.uk.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Kühlbrandt
authors.affiliation: London School of Hygiene and Tropical Medicine, European Centre on Health of Societies in Transition, 14-17 Tavistock Place, London WC1 9SH, United Kingdom. Electronic address: dina.balabanova@lshtm.ac.uk.
authors.forename: Dina
authors.initials: D
authors.lastname: Balabanova
authors.affiliation: Curatio International Foundation, Tbilisi, Georgia. Electronic address: i.chikovani@curatio.com.
authors.forename: Ivdity
authors.initials: I
authors.lastname: Chikovani
authors.affiliation: School of Public Health, American University of Armenia, Yerevan, Armenia. Electronic address: vpetrosi@aua.am.
authors.forename: Varduhi
authors.initials: V
authors.lastname: Petrosyan
authors.affiliation: Social and Humanitarian Research Institute of V.N. Karazin, Kharkiv National University, Kharkiv, Ukraine. Electronic address: oxana.86@gmail.com.
authors.forename: Kseniya
authors.initials: K
authors.lastname: Kizilova
authors.affiliation: Center for Sociological and Political Researches, Belarusian State University, Minsk, Belarus. Electronic address: ivanuto@rambler.ru.
authors.forename: Oksana
authors.initials: O
authors.lastname: Ivaniuto
authors.affiliation: ISIS 'OPINIA', 129 31 August Street, Chisnau, Republic of Moldova. Electronic address: olga.danii@gmail.com.
authors.forename: Olga
authors.initials: O
authors.lastname: Danii
authors.affiliation: Open Health Institute, Moscow, Russian Federation.
authors.forename: Noune
authors.initials: N
authors.lastname: Makarova
authors.affiliation: London School of Hygiene and Tropical Medicine, European Centre on Health of Societies in Transition, 14-17 Tavistock Place, London WC1 9SH, United Kingdom. Electronic address: martin.mckee@lshtm.ac.uk.
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
mesh_terms: D001136:Armenia; D003906:Developing Countries / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000628:therapy*; D006304:Health Status; D006801:Humans; D008966:Moldova; D018802:Patient-Centered Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D002094:Republic of Belarus; D012426:Russia; D012648:Self Care; D014455:Ukraine
keywords: Access to care; Chronic illness; Diabetes; Former Soviet Union; Health system research; Patient-centred care; Quality of care