Management of diabetes patients with comorbidity in primary care: a mixed-method study in Odisha, India.

BACKGROUND: Diabetes patients with comorbidities need regular and comprehensive care for their disease management. Hence, it is essential to assess the primary care preparedness for managing diabetes patients and the perspectives of the diabetes patients on the care received at the primary care facilities. METHODS: All 21 Urban Primary Health Centres (UPHCs) in Bhubaneswar city of Odisha, India, were assessed using the modified Primary Care Evaluation Tool and WHO Package of Essential Non-communicable disease interventions questionnaire. Additionally, 21 diabetes patients with comorbidities were interviewed in-depth to explore their perception of the care received at the primary care facilities. RESULTS: All the UPHCs had provisions to meet the basic requirements for the management of diabetes and common comorbidities like hypertension. There were few provisions for chronic kidney illness, cardiovascular disease, mental health, and cancer. Diabetes patients felt that frequent change in primary care physicians at the primary care facilities affected their continuity of care. Easy accessibility, availability of free medicines, and provisions of basic laboratory tests at the facilities were felt to be necessary by the diabetes patients. CONCLUSION: Our study highlights the existing gaps in India's healthcare system preparedness and the needs of diabetes patients with comorbidity. The government of India's Health and Wellness (HWC) scheme aims to deliver comprehensive healthcare to the population and provide holistic care at the primary care level for NCD patients. It is imperative that there is an early implementation of the various components of the HWC scheme to provide optimal care to diabetes patients.

Managing diabetes mellitus with comorbidities in primary healthcare facilities in urban settings: a qualitative study among physicians in Odisha, India.

AIM: To explore the perceived barriers and facilitators in the management of the patients having diabetes with comorbidities by primary care physicians. METHODS: A qualitative In-Depth Interview study was conducted among the primary care physicians at seventeen urban primary health care centres at Bhubaneswar city of Odisha, India. The digitally recorded interviews were transcribed verbatim and translated into English. The data were analysed using thematic analysis. RESULTS: Barriers related to physicians, patients and health system were identified. Physicians felt lack of necessary knowledge and skills, communication skills and overburdening due to multiple responsibilities to be major barriers to quality care. Patients' attitude and beliefs along with socio-economic status played an important role in treatment adherence and in the management of their disease conditions. Poor infrastructure, irregular medicine supply, and shortage of skilled allied health professionals were also found to be barriers to optimal care delivery, as was the lack of electronic medical records and personal treatment records. CONCLUSION: Comprehensive guidelines with on the job training for capacity building of the physicians and creation of multidisciplinary teams at primary care level for a more holistic approach towards management of diabetes with comorbidities could be the way forward to optimal delivery of care.

Family medicine education in India: A panoramic view.

INTRODUCTION: In the recent years, there has been renewed interest in strengthening primary care for improved health services delivery. Family medicine with its holistic principles is an effective approach for building primary care workforce in resource constraint settings. Even though this discipline is well established and mainstreamed in Western countries, the same is yet to occur in low- and middle-income nations. India with its paradigm shift for universal health coverage is strategically poised to embrace family medicine as a core component of its health system. However, till date, a clear picture of family medicine teaching across the country is yet to be available. METHODS: This paper makes an attempt to assess the landscape of family medicine teaching in India with an aim to contribute to a framework for bolstering its teaching and practice in coming years. The objective was to obtain relevant information through a detailed scan of the health professional curricula as well as mapping independent academic programs. Specific areas of interest included course content, structure, eligibility criteria, and accreditation. RESULTS: Our findings indicate that teaching of family medicine is still in infancy in India and yet to be mainstreamed in health professional education. There are variations in family medicine teaching across academic programs. CONCLUSION: It is suggested that both medical and nursing colleges should develop dedicated Departments of Family Medicine for both undergraduate and postgraduate teaching. Further, more number of standalone diploma courses adopting blended learning methods should be made available for in-service practitioners.