'A one-to-one thing is better than a thousand books': views and understanding of older people with diabetes.

ABSTRACT

BACKGROUND: Specific aspects of care have been identified as important in order to provide high-quality care for patients with diabetes, including the need for patients to understand their condition. Little research has specifically explored the views and understanding of older people with diabetes in primary care. AIMS: To explore views on quality of diabetes care and to gauge patients' understanding of their condition in order to identify areas for improvement in care. METHODS: During August and September 2012, 13 semi-structured interviews were held with people with diabetes aged over 75 years, recruited from an inner-city general practice. The interviews focused on three areas (1) their understanding of diabetes, (2) their views on the information they had received, and (3) their views on the quality of their care. The qualitative data were analysed using N-Vivo and techniques derived from framework analysis. RESULTS: A basic understanding of diabetes was shared among the responders, but certain gaps were identified, notably misunderstandings regarding hypoglycaemia and diabetic coma. Information was valued most if given in person; written information may not be impactful. Educational input attenuated over time and patients did not actively seek updating. Personal care was appreciated, but many patients expressed a desire to be kept better informed about their treatment. CONCLUSIONS: Older people with diabetes wish to be involved in their care. Healthcare providers should regularly assess patients' knowledge in order to resolve potentially harmful misunderstandings. Explanations should be detailed and repeated, and sources of information need to be user-friendly as appropriate to this age group. Nurse-led, more continuous care was highly acceptable.