Concordance and discordance between primary and secondary care health workers in perceptions of barriers to diabetes care

Aims: To understand differences between primary care health professionals and secondary care health workers in their perceptions of barriers to good diabetes care. Methods: Practice nurses and general practitioners in the Waikato region of New Zealand were surveyed to ascertain their perceptions (as primary health care workers) of barriers to diabetes care; 315 replies were received (70% response rate). Secondary care health professionals working at Waikato Hospital were similarly surveyed; 123 replies were received (71% response rate). Results: Primary care health workers are more likely than secondary health care workers to rate motivation, self-belief, financial issues, lack of governmental funding, lack of public awareness of diabetes, and lack of symptoms as barriers to care. Secondary health care workers are significantly more likely to rate appointment systems, inappropriate cultural messages, lack of community-based services, high prevalence of diabetes, and unhelpful health practitioners. Conclusions: Better understanding of the respective differences in perceptions between primary and secondary care may assist the development of a more functional and unified health system. It is suggested that greater emphasis on individual diabetes education and a stronger focus on motivation and lifestyle changes at both the individual and community levels may improve outcomes.