Vergleichende Evaluation zweier Instrumente zur kardiovaskulären Risikoberatung in der Hausarztpraxis: CARRISMA und e-ARRIBA. Auswirkung auf Veränderungsmotivation & Partizipative Entscheidungsfindung

International challenges without borders: a descriptive study of family physicians' educational needs in the field of diabetes

BACKGROUND

The optimal care of persons with diabetes by general practitioners and family physicians (GP/FP) is complex and requires multiple competencies. This is a fairly unrecognized key challenge in the healthcare systems. In some cases, local and national Continuous Professional Development (CPD) initiatives target these challenges; however there have been few international initiatives, possibly because challenges emerging from different studies have not been linked across national boundaries. In this context, the authors have compiled data about gaps and/or barriers inherent to GP/FP care of persons with type 2 diabetes from Austria, Canada, Germany and the United Kingdom.

METHODS

Secondary analyzes of pre-existing studies were conducted to identify challenges in the care of patients with type 2 diabetes as faced by GPs/FPs. Two sources of data were reviewed: unpublished research data from collaborating organizations and articles from a literature search (in English and German). Articles retrieved were scanned by the research team for relevance to the study objectives and to extract existing gaps and barriers. The identified challenges were then categorized along three major axes: (1) phase of the continuum of care {from screening to management}; (2) learning domain {knowledge, skills, attitudes, behavior, context}; and (3) by country/region. Compilation and categorization were performed by qualitative researchers and discrepancies were resolved through discussion until concordance was achieved.

RESULTS AND DISCUSSION

Thirteen challenges faced by GPs/FPs in the care for patients with type 2 diabetes were common in at least 3 of the 4 targeted countries/regions. These issues were found across the entire continuum of care and included: pathophysiology of diabetes, diagnostic criteria, treatment targets assessment, drugs' modes of action, decision-making in therapies, treatment guidelines, insulin therapy, adherence, management of complications, lifestyle changes, team integration, bureaucracy and third-party payers. The issues reported were not restricted to the physicians' knowledge, but also related to their skills, attitudes, behaviours and context.

CONCLUSIONS

This study revealed challenges faced by GPs/FPs when caring for patients with diabetes, which were similar across international and health system borders. Common issues might be addressed more efficiently through international educational designs, adapted to each country's healthcare system, helping develop and maintain physicians' competencies.

Assessing reported adherence to pharmacological treatment recommendations. Translation and evaluation of the Medication Adherence Report Scale (MARS) in Germany

Objectives Patients' self-report of medicine taking is a feasible method of assessing their adherence to prescribed pharmacological treatment. Aim of this study was to assess whether the German version of the Medication Adherence Report Scale (MARS-D) is an appropriate instrument for measuring patient adherence. Methods After translation into German, the questionnaire was sent to 1488 patients with chronic diseases and patients with risk factors of cardiovascular disease. Reliability and validity of the MARS-D were assessed and compared with the psychometric properties of the original English version. The relationship between patients' characteristics and adherent behaviour was estimated using bivariate correlation and a linear regression model. Results The MARS-D was analysed if patients were taking medicines and the MARS-D was complete leaving 523 (35.1%) analysable questionnaires. Internal consistency of the MARS-D (Cronbach's alpha 0.60-0.69) was satisfactory and comparable to the English original (Cronbach's alpha 0.69-0.90). Test-retest reliability was satisfactory (Pearson's r 0.61-0.63), however, lower than in the English sample (r = 0.97). Convergent validity was low but showed statistical significance. Patient socio-demographic characteristics had weak influence on MARS-D score indicating high reported adherence for older patients (P < 0.05), patients with German mother tongue (P < 0.05) and high number of medicines (P < 0.01). Conclusions Preliminary psychometric evaluation of the MARS-D is encouraging. MARS-D is an appropriate measure to detect patients at risk of non-adherence. The MARS-D could be used in routine care to support communication about the medication taking behaviour, as self-report of non-adherent behaviour corresponds to the facts.