title: Using the patient-centred medicine clinical framework to better appreciate and explore the many barriers to care in type 2 diabetes.
abstract: There are many barriers to diabetes care. This paper explores whether organising these barriers to Type 2 diabetes care within the clinical framework of patient-centred medicine (PCM) enables a better appreciation and conceptualisation of these barriers. The terms 'diabetes', 'barriers to care', 'self-management', 'patient-centred care' and 'outcome assessment' were used to identify 28 articles describing multiple barriers (minimum of three) to care in Type 2 diabetes. Identified barriers were organised within the clinical framework of PCM. Barriers to diabetes care were numerous and diverse, but all could be accommodated within the PCM framework, except for one, that of patient non-compliance (non-adherence). This paternalistic concept contradicts patient autonomy, a key component of the PCM paradigm. Accepting non-adherence as a plausible barrier stops providers from recognising the actual barriers to diabetes self-management. Clinicians need to stop attributing blame for poor disease outcomes on patients, and instead to become partners in identifying and addressing their patients' real barriers to better health by using the practical clinical framework of PCM.
authors.affiliation: Wairoa Medical Centre, PO Box 341, Wairoa, Hawke's Bay, New Zealand. ronjanes@xtra.co.nz.
authors.forename: Ron
authors.initials: R
authors.lastname: Janes
authors.forename: Janet
authors.initials: J
authors.lastname: Titchener
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D010349:Patient Compliance / Q000523:psychology*; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D012648:Self Care