Factors influencing the delivery of evidence-based interventions for diabetes mellitus type 2 prevention in primary care

Abstract

Diabetes mellitus (DM) is a chronic condition with serious long-term complications and its global prevalence is ever-increasing. With the local prevalence of DM standing at 10.3% and a projected prevalence of 12.47% for 2045, the burden posed by DM represents a substantial economic burden for the Maltese healthcare system. Randomised control trials have shown that the onset of DM type 2 may be prevented or delayed by targeting modifiable risk factors. Translating the provision of evidence-based interventions into clinical settings is complex and the views of professionals invaluable in ensuring that strategies for prevention are effective. This study aims to identify factors that impact the provision of interventions for DM type 2 prevention in Primary Health Care. To fulfil the aims and objectives of this study, the mixed-method approach was deemed the most appropriate. General practitioners (GPs) in clinical practice were asked to complete a questionnaire with the aim of quantifying their knowledge, attitudes and views regarding prediabetes. This was complemented by qualitative research using semi-structured interviews conducted with GPs who hold an administrative role within the Primary Health Care Department. Quantitative data was analysed using frequency analyses, tests for independence and logistic regression while thematic analysis of qualitative data was carried out. This study revealed major deficits in GP knowledge of all the core elements of guidelines for the diagnosis and management of prediabetes. Statistically significant results were found between knowledge and age range as well as the use of guidelines. Lack of counselling time (85.9 %) and patient motivation (96.9%) were regarded as important barriers for diabetes prevention. Thematic analysis revealed mixed views regarding the results obtained from the questionnaire. Ultimately, this study revealed the need for increased GP education and system-level changes in relation to type 2 DM prevention services. A number of recommendations were drawn up regarding general practitioner education, clinical practice and future research.