Patients' experiences of diabetes education teams integrated into primary care.

OBJECTIVE: To explore patients' perspectives on care received from diabetes education teams (a registered nurse and a registered dietitian) integrated into primary care. DESIGN: Qualitative study using semistructured, one-on-one interviews. SETTING: Three diabetes education programs operating in 11 primary care sites in one region of Ontario. PARTICIPANTS: Twenty-three patients with diabetes. METHODS: Purposeful sampling was used to recruit participants from each site for interviews. Educator teams invited patients with whom they had met at least once to participate in semistructured interviews. Data were analyzed using thematic analysis with NVivo 11 software. MAIN FINDINGS: The diabetes education teams integrated into primary care exhibited many of the principles of person-centred care, as evidenced by the 2 overarching themes. The first is personalized care, with the subthemes care environment, shared decision making, and patient preference for one-on-one care. Participants described feeling included in partnerships with their health care providers, as they collaborated with physicians and diabetes educators to develop knowledge and set goals in the convenience and comfort of their usual primary care settings. Many participants also expressed a preference for one-on-one sessions. The second theme is patient-provider relationship, with the subthemes respect, supportive interaction, and facilitating patient engagement. Supportive environments created by the educators built trusting relationships, where patients expressed enhanced motivation to improve their self-care. CONCLUSION: Diabetes educators integrated into primary care can serve to enrich the experience of patients, provide key education to improve patient understanding, and support primary care physicians in providing timely and comprehensive clinical care. Diabetes patients appear to benefit from convenient access to interprofessional teams of educators in primary care to support diabetes self-management.

Obstetric healthcare providers' perceptions of communicating gestational weight gain recommendations to overweight/obese pregnant women.

BACKGROUND: Gestational weight gain (GWG) is a major risk factor of poor pregnancy outcomes. Obese pregnant women frequently report bias and discrimination when dealing with healthcare providers (HCPs). Effective communication of GWG recommendations may impact risks. Study objectives were to identify perceptions of HCPs in communicating GWG recommendations and to identify potential gaps/opportunities that could be addressed in the development of appropriate materials/programmes. METHODS: A survey tool was created using the Theory of Planned Behaviour to capture HCPs' attitudes, behaviours and intentions, using four-point Likert questions. Surveys were distributed to obstetricians/gynaecologists, family physicians, obstetric residents/ fellows, midwives, registered/public health nurses and registered dietitians. RESULTS: Results from 96 surveys show that HCPs agreed discussing GWG was important (100%), beneficial for patient-provider rapport (86%) and best practice (100%); however, most found it unpleasant (68%). Providers have confidence in their skills to provide nutrition advice (71%) and believe they have sufficient training (56%); yet, 31% acknowledged making derogatory comments and indicated that they could improve their communication of GWG (92%). CONCLUSIONS: HCPs believe they are providing GWG recommendations in an effective and empathetic manner. While an underlying current of bias/discrimination remains, there is recognition of the importance of more training and access to appropriate tools.