title: Making sense of change: patients' views of diabetes and GP-led integrated diabetes care.
abstract: BACKGROUND
  Health system reform is directed towards better management of diabetes. However, change can be difficult, and patients' perspectives are a key aspect of implementing change.
  
  
  OBJECTIVE
  This study investigated patients' perceptions and experiences of type 2 diabetes (T2DM), self-care and engagement with GP-led integrated diabetes care.
  
  
  METHODS
  Qualitative interviews were conducted with purposively selected patients with T2DM following their initial medical appointment in the new model of care. Normalization process theory was used to orientate the thematic analysis, to explain the work of implementing change.
  
  
  METHODS
  Two specialist GP-based complex diabetes services in primary care in Brisbane, Australia.
  
  
  METHODS
  Intervention group patients (n = 30) in a randomized controlled trial to evaluate a model of GP-led integrated care for complex T2DM.
  
  
  METHODS
  Participants' experiences and perceptions of diabetes management and a GP-led model of care.
  
  
  RESULTS
  Three themes were identified: sensibility of change, 'diabetic life' and diabetes care alliance. The imperative of change made sense, but some participants experienced dissonance between this rational view and their lived reality. Diabetes invaded life, revealing incongruities between participants' values and living with diabetes. They appreciated a flexible and personalized approach to care.
  
  
  CONCLUSIONS
  Participants responded to advice in ways that seemed rational within the complexities of their life context. Their diabetes partnerships with health professionals coupled providers' biomedical expertise with patients' contextual expertise.
  
  
  CONCLUSIONS
  Learning to manage relationships with various health professionals adds to patients' diabetes-related work. Providers need to adopt a flexible, interactive approach and foster trust, to enable better diabetes care.
authors.affiliation: Discipline of General Practice, School of Medicine, The University of Queensland, Herston, Queensland, Australia.
authors.forename: Letitia H
authors.initials: LH
authors.lastname: Burridge
authors.affiliation: Social Work and Social Policy, School of Social Work and Human Services, The University of Queensland, St Lucia, Queensland, Australia.
authors.forename: Michele M
authors.initials: MM
authors.lastname: Foster
authors.affiliation: Discipline of General Practice, School of Medicine, The University of Queensland, Herston, Queensland, Australia.
authors.forename: Maria
authors.initials: M
authors.lastname: Donald
authors.affiliation: Discipline of General Practice, School of Medicine, The University of Queensland, Herston, Queensland, Australia.
authors.forename: Jianzhen
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Russell
authors.affiliation: Discipline of General Practice, School of Medicine, The University of Queensland, Herston, Queensland, Australia.
authors.forename: Claire L
authors.initials: CL
authors.lastname: Jackson
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010465:Perception; D036301:Qualitative Research; D012648:Self Care / Q000523:psychology*; D012959:Socioeconomic Factors
keywords: GP-led integrated care; general practitioner; normalization process theory; primary care; self-care; type 2 diabetes