"I have got diabetes!" - interviews of patients newly diagnosed with type 2 diabetes

BACKGROUND

To be diagnosed with type 2 diabetes is a challenge for every patient. There are previous studies on patients' experience in general but not addressing the increased cardiovascular risk and multifactorial treatment. The aim of this study was to explore the thoughts, experiences and reactions of newly diagnosed patients with diabetes to this diagnosis and to the risk of developing complications.

METHODS

Ten adults (7 men/3 women, aged 50-79) diagnosed with type 2 diabetes within the last 12 months were interviewed at a primary health care center in Sweden. An interview guide was used in the semi-structured interviews that were transcribed verbatim. The analysis was qualitative and inspired by systematic text condensation (Malterud). The text was read several times and meaning units were identified. Related meaning units were sorted into codes and related codes into categories during several meetings between the authors. Finally, the categories were merged and formed themes.

RESULTS

We defined three main themes: Reaction to diagnosis, Life changes and Concerns about the future. Most patients reacted to the diagnosis without intensive feelings. Lifestyle changes were mainly accepted but hard to achieve. The patients' major concerns for the future were the consequences for daily life (being able to drive and read) and concerns for relatives rather than anxieties regarding medical issues such as laboratory tests. There were considerable differences in how much patients wanted to know about their future risks.

CONCLUSIONS

The results of this study might help to focus doctor-patient communication on issues highlighted by the patients and on the importance of individualizing information and recommendations for each patient.

Uncertainty in clinical practice - an interview study with Swedish GPs on patients with sore throat

BACKGROUND

Uncertainty is inevitable in clinical practice in primary care and tolerance for uncertainty and concern for bad outcomes has been shown to vary between physicians. Uncertainty is a factor for inappropriate antibiotic prescribing. Evidence-based guidelines as well as near-patient tests are suggested tools to decrease uncertainty in the management of patients with respiratory tract infections. The aim of this paper was to describe strategies for coping with uncertainty in patients with pharyngotonsillitis in relation to guidelines.

METHODS

An interview study was conducted among a strategic sample of 25 general practitioners (GPs).

RESULTS

All GPs mentioned potential dangerous differential diagnoses and complications. Four strategies for coping with uncertainty were identified, one of which was compliant with guidelines, "Adherence to guidelines", and three were idiosyncratic: "Clinical picture and C-reactive protein (CRP)", "Expanded control", and "Unstructured". The residual uncertainty differed for the different strategies: in the strategy "Adherence to guidelines" and "Clinical picture and CRP" uncertainty was avoided, based either on adherence to guidelines or on the clinical picture and near-patient CRP; in the strategy "Expanded control" uncertainty was balanced based on expanded control; and in the strategy "Unstructured" uncertainty prevailed in spite of redundant examination and anamnesis.

CONCLUSION

The majority of the GPs avoided uncertainty and deemed they had no problems. Their strategies either adhered to guidelines or comprised excessive use of tests. Thus use of guidelines as well as use of more near-patient tests seemed associated to reduced uncertainty, although the later strategy at the expense of compliance to guidelines. A few GPs did not manage to cope with uncertainty or had to put in excessive work to control uncertainty.

[Better communication between primary health care providers and hospital physicians. The Danish health care consultation model]

A successful model of liaison between the primary and secondary (hospital) levels of health care entails improved co-operation between hospital doctors and general practitioners (GPs). Since its introduction in Denmark in 1991, this approach has been adopted in Sweden and, to a lesser extent, in Norway. Important principles of the model include: 1) both at the primary and secondary level, responsibility for cooperation rests with the physicians themselves; 2) all physicians at both levels are involved; 3) liaison is maintained by selected GPs serving as liaison officers acting in concert under the guidance of a coordinator; 4) liaison officers are responsible for cultivating personal contacts and good relations at hospitals, and promoting interest in and commitment to the system. Evaluation of the model requires both quantitative and qualitative studies. Although few evaluations have been completed, and no definite conclusions can be drawn, the preliminary results of current evaluations in progress in Sweden and Norway are promising, as are the reported experiences of those who use the system. A Nordic ad hoc group has been actively engaged in promoting the quality of primary-secondary health care liaison since 1997.