title: Primary and tertiary health professionals' views on the health-care of patients with co-morbid diabetes and chronic kidney disease - a qualitative study.
abstract: Health-care for co-morbid diabetes and chronic kidney disease (CKD) is often sub-optimal. To improve health-care, we explored the perspectives of general practitioners (GPs) and tertiary health-care professionals concerning key factors influencing health-care of diabetes and CKD.
  
  
  
  A total of 65 health professionals were purposively sampled from Australia's 2 largest cities to participate in focus groups and semi-structured interviews. Four focus groups were conducted with GPs who referred to 4 tertiary health services in Australia's 2 largest cities, with 6 focus groups conducted with tertiary health-care professionals from the 4 tertiary health services. An additional 8 semi-structured interviews were performed with specialist physicians who were heads of diabetes and renal units. All discussions were facilitated by the same researcher, with discussions digitally recorded and transcribed verbatim. All qualitative data was thematically analysed independently by 2 researchers.
  
  
  
  Both GPs and tertiary health-care professionals emphasised the importance of primary care and that optimal health-care was an inter-play between patient self-management and primary health-care, with specialist tertiary health-care support. Patient self-management, access to specialty care, coordination of care and a preventive approach were identified as key factors that influence healthcare and require improvement. Both groups suggested that an integrated specialist diabetes-kidney service could improve care. Unit heads emphasised the importance of quality improvement activities.
  
  
  
  GPs and tertiary health-care professionals emphasised the importance of patient self-management and primary care involvement in the health-care of diabetes and CKD. Supporting GPs with an accessible, multidisciplinary diabetes-renal health service underpinned by strong communication pathways, a preventive approach and quality improvement activities, may improve health-care and patient outcomes in co-morbid diabetes and CKD.
authors.affiliation: Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.|Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia.
authors.forename: Clement
authors.initials: C
authors.lastname: Lo
authors.affiliation: Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia.
authors.forename: Dragan
authors.initials: D
authors.lastname: Ilic
authors.affiliation: Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.|Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia.
authors.forename: Helena
authors.initials: H
authors.lastname: Teede
authors.affiliation: Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: Greg
authors.initials: G
authors.lastname: Fulcher
authors.affiliation: The George Institute for Global Health, Sydney, NSW, Australia.|Department of Nephrology, Concord Hospital, Sydney, NSW, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: Gallagher
authors.affiliation: Department of Nephrology, Monash Health, Clayton, Victoria, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kerr
authors.affiliation: Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia.
authors.forename: Kerry
authors.initials: K
authors.lastname: Murphy
authors.affiliation: Department of Nephrology, Monash Health, Clayton, Victoria, Australia.
authors.forename: Kevan
authors.initials: K
authors.lastname: Polkinghorne
authors.affiliation: School of Primary Health Care, Monash University, Clayton, Victoria, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Russell
authors.affiliation: Department of General Practice, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Usherwood
authors.affiliation: Department of Renal Medicine, Alfred Health, Prahran, Victoria, Australia.
authors.forename: Rowan
authors.initials: R
authors.lastname: Walker
authors.affiliation: Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia. sophia.zoungas@monash.edu.|Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia. sophia.zoungas@monash.edu.|The George Institute for Global Health, Sydney, NSW, Australia. sophia.zoungas@monash.edu.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D001315:Australia; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D058006:General Practice; D006297:Health Services Accessibility; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D011320:Primary Health Care; D036301:Qualitative Research; D058996:Quality Improvement; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000628:therapy*; D012648:Self Care; D063128:Tertiary Health Care
keywords: Chronic kidney disease; Diabetes; Focus groups; Health-care; Health-care delivery; Multi-morbidity; Primary care; Qualitative; Tertiary care