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Gaps and barriers in health-care provision for co-morbid diabetes and chronic kidney disease: a cross-sectional study.

Gaps and barriers in health-care provision for co-morbid diabetes and chronic kidney disease: a cross-sectional study.
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Lo C, Teede H, Fulcher G, Gallagher M, Kerr PG, Ranasinha S, Russell G, Walker R, Zoungas S,


Lo C, Teede H, Fulcher G, Gallagher M, Kerr PG, Ranasinha S, Russell G, Walker R, Zoungas S, (click to view)

Lo C, Teede H, Fulcher G, Gallagher M, Kerr PG, Ranasinha S, Russell G, Walker R, Zoungas S,

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BMC nephrology 2017 02 2818(1) 80 doi 10.1186/s12882-017-0493-x
Abstract
BACKGROUND
Patients with diabetes and chronic kidney disease (CKD) are a complex subset of the growing number of patients with diabetes, due to multi-morbidity. Gaps between recommended and received care for diabetes and chronic kidney disease (CKD) are evident despite promulgation of guidelines. Here, we document gaps in tertiary health-care, and the commonest patient-reported barriers to health-care, before exploring the association between these gaps and barriers.

METHODS
This cross-sectional study recruited patients with diabetes and CKD (eGFR < 60 mL/min/1.73 m(2)) across 4 large hospitals. For each patient, questionnaires were completed examining clinical data, recommended care, and patient-reported barriers limiting health-care. Descriptive statistics, subgroup analyses by CKD stage and hospital, and analyses examining the relationship between health-care gaps and barriers were performed. RESULTS
308 patients, of mean age 66.9 (SD 11.0) years, and mostly male (69.5%) and having type 2 diabetes (88.0%), participated. 49.1% had stage 3, 24.7% stage 4 and 26.3% stage 5 CKD. Gaps between recommended versus received care were evident: 31.9% of patients had an HbA1c ≥ 8%, and 39.3% had a measured blood pressure ≥ 140/90 mmHg. The commonest barriers were poor continuity of care (49.3%), inadequate understanding/education about CKD (43.5%), and feeling unwell (42.6%). However, barriers associated with a failure to receive items of recommended care were inadequate support from family and friends, conflicting advice from and poor communication amongst specialists, the effect of co-morbidities on self-management and feeling unmotivated (all p < 0.05). CONCLUSIONS
Barriers to health-care varied across CKD stages and hospitals. Barriers associated with a deviation from recommended care were different for different items of care, suggesting that specific interventions targeting each item of care are required.

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