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Physicians’ Perceptions of Barriers to Cardiovascular Disease Risk Factor Control among Patients with Diabetes: Results from the Translating Research into Action for Diabetes (TRIAD) Study

Research Division, Department of Family Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Somerset (JCC, GJD, SR)
Pacific Health Research Institute and the Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu (C-WT)
Division of Research, Kaiser Permanente Medical Care Program, Oakland, California (JAS, BS)
Division of Metabolism, Endocrinology, and Diabetes (KO), University of Michigan, Ann Arbor
Ann Arbor Center of Excellence, Division of General Medicine (MH), University of Michigan, Ann Arbor
Department of Medicine, Indiana University School of Medicine, Indianapolis (US)
Preventive Cardiology Program, Department of Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark (NL)

Correspondence: Corresponding author: Jesse C. Crosson, PhD, Department of Family Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, 1 World's Fair Drive, Room 1500, Somerset, NJ 08873 (E-mail: jesse.crosson{at}umdnj.edu)

Introduction: Many patients with diabetes have poorly controlled blood glucose, lipid, or blood pressure levels, increasing their risk for cardiovascular disease (CVD) and other complications. Relatively little is known about what physicians perceive to be barriers to good CVD risk factor control or their own role in helping patients achieve good control.

Methods: We interviewed 34 primary care physicians in 4 states to assess their perceptions of patients’ barriers to CVD risk factor control. Interviews were coded and analyzed for emergent themes.

Results: Physicians attributed barriers primarily to patients (socioeconomic issues, competing medical conditions, and lack of motivation) or to health system barriers (cost of care or lack of a multidisciplinary team). Physicians also expressed high levels of frustration with their efforts to address barriers.

Conclusions: Physicians felt that barriers to CVD risk factor control often were beyond their abilities to address. Training physicians or other members of the primary health care team to address patients’ personal barriers and health system barriers to good control could help alleviate high frustration levels, improve relationships with patients, and improve the treatment of diabetes. Supporting such efforts with adequate reimbursement should be a focus of health care reform.

Key Words: Patient/Physician Relations • Diabetes Control • Primary Health Care • Qualitative

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