Diabetes-Related Healthcare Services in Nepal—A Qualitative Exploration of Healthcare Professionals’ Opinions
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Sample
- Web-pages of different hospitals and healthcare centres.
- Specific hospitals, clinics and pharmacies in Kathmandu Valley providing services to people with diabetes.
- ‘Snowballing’: Recruited HCPs were requested to contact other HCPs who may be willing to participate in the study, and to ask those HCPs to contact the researcher for participation. Similarly, the recruited HCPs were requested to provide the public contact details of other HCPs who may be interested in the study, for the researchers to contact them.
2.3. Data Collection
2.4. Data Analysis
3. Results
3.1. Participant Demographics
3.2. Interpreted Themes
3.2.1. Theme 1: Delivering Care for Patients with Diabetes
3.2.2. Theme 2: Healthcare Professionals Partnering for Wholistic Care in Diabetes Management
Physicians’ Role
Nurses’ Role
Dieticians’ Role
Pharmacists/Pharmacy Staffs’ Role
‘Here we speak with limitations; if we speak more the patient is irritated. Yes, patients get irritated. If we start teaching them a lot of thing, what he (the patient) feels is that he (the pharmacist) is saying all these to sell his medications. He thinks that we are acting as if we know everything. You shouldn’t speak unless they ask… that will wreck everything!’. (P29, Pharmacist)
‘Now one thing that you have been employed here is to sell medications. If you start doing other things, there is so much crowd in the pharmacy, the director will come and reprimand you’. (P29, Pharmacist)
Traditional Medication Prescribers’ Role
3.2.3. Theme 3: Challenges to Effective Diabetes Care Delivery
Sub-Theme 1: Shortages of Quality Healthcare Facilities and Workforce
Sub-Theme 2: Daily Burden of Patient Care
Sub-Theme 3: Inconsistency in Care Provision
Sub-Theme 4: Lack of Effective Interprofessional Collaboration
3.2.4. Theme 4: Perceived Strategies to Optimise Care in the Healthcare System
4. Discussion
Study Limitations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Key Broad Questions Asked in the In-Depth Interviews: | |
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1. | Could you please describe your typical role in providing services to patients with type 2 diabetes? |
2. | What are the current healthcare services that are provided to patients with type 2 diabetes? |
3. | How do you think these existing healthcare services influence patients’ diabetes care? |
4. | What impact (of these services) have you seen? |
5. | What strategies do you use to promote effective diabetes management? |
6. | How do you think we can help patients better manage their diabetes overall? |
Demographic Variable | N |
---|---|
Gender | |
Male | 19 |
Female | 11 |
Age Bracket | |
20–30 years | 6 |
31–40 years | 13 |
41–50 years | 5 |
51–60 years | 4 |
61–70 years | 2 |
Profession | |
Physicians (General Physicians, Internal Medicine specialists, Endocrinologists, Diabetologists and Sports Physician) | 13 |
Ayurvedic physicians * | 6 |
Pharmacy staff | 5 |
Pharmacists (Hospital + Community) | 3 (2 + 1) |
Pharmacy Assistant ** (Community) | 1 |
Health assistant *** (Community) | 1 |
Nurses | 2 |
Dieticians | 4 |
Professional Experience (years) | |
Range | 0.5–36 |
Median | 8 |
Mean | 13.1 |
Approximate Number of Patients with Type 2 Diabetes Served/Week | |
<5 | 1 |
5–10 | 4 |
11–19 | 9 |
>20 | 16 |
Themes |
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|
|
|
Quotes Illustrating the Problems in Healthcare Provision and Their Solutions | |
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Q1 | Deficiency in monitoring ‘The problem with HbA1c (monitoring) in Nepal is, standard kits are not being used. When standard kits are not used, then, despite paying so much money, you are not getting a good reliable report. That is also a big problem here. Although they claim it! … So, meaning, internationally recommended processes, methods are not used, no?’ (P14, Physician) |
Q2 | Collaboration and trainings to build qualified manpower ‘We need to develop a team. No, we should not go only for physicians, there has to be nursing … educators… means anybody who can convincingly take classes like it could be social-worker or teacher or volunteer, no? Who can…where we educate them about diabetes and they will use the teaching material to teach the local people about diabetes and its prevention, and the patients about diabetes and its control…and its monitoring, no? So, from what I have observed in Nepal is, we don’t have a team. We need training facilities (to develop) diabetes educator, and we need nurses working in diabetes to help, an…in you know checking and monitoring them, and then we need, an… people physicians with special interest in diabetes! Of course, diabetes should be treated by any physician, but diabetes has progressed so rapidly in its treatment and its monitoring, no? That now you cannot (easily keep up). So, we need people who are really interested and educated about diabetes treatment’. (P14, Physician) |
Q3 | Inconsistency in care and need for guidelines ‘ An individual’s effort is not sufficient. For example, if I say, if I prescribe (a medication), saying that “you have to take it”. Now he will go to the other doctor. Why? (because the patient thinks, the next doctor) may be he will say “don’t take (medications)?” Now this next doctor has to say “you have to take the medications”. Here, even between doctors this doesn’t match. Now when here I have said that “you have to take it”, then he (the other doctor) says… “no, no..” to show that he is better than the others… “don’t, don’t take the medicines now… you increase the Ayurvedic, exercise… and then come after 3 months”, for the patient, that (doctor) is good. For patients, doctor who does prescribe insulin or medicines… that doctor is good! We have to change this. What I write should not be contradicted by the other!… The patient may visit five doctors… doctor shop…if all five voice the same, that “you need medicines”, only then patients will accept, “medicines are really required for me”! So we should have this system in Nepal. There has to be one guideline… that tells that when the sugar level reaches this and this, you should take medications. The guidelines which all the doctors will follow..then, whichever doctor you go to, it will be the same’ (P18, Physician) |
Q4 | Need for national data/ research ‘(Necessary is) Data! Data collection, no? Anybody in the world asks me what is the situation of diabetes in Nepal. I feel like, “hmm… in my clinic I see a 100 patient…” and “what happen to them?”, “I don’t know”. So…ya... that’s like the saddest part! That we have no data collection, we have no epidemiology. Everything is in pockets. There is no national centre. We don’t know how many of these are ending up with cancer, what is happening with the thyroid patients… there is like no data. And that is what is really scary. Just working in the dark. Thinking they are right… extrapolating data from India, or China or America and then you are just putting them onto your people, which has been time and again proved that that is not the same.’ (P27, Physician) |
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Sapkota, S.; Brien, J.-a.E.; Aslani, P. Diabetes-Related Healthcare Services in Nepal—A Qualitative Exploration of Healthcare Professionals’ Opinions. Pharmacy 2020, 8, 131. https://doi.org/10.3390/pharmacy8030131
Sapkota S, Brien J-aE, Aslani P. Diabetes-Related Healthcare Services in Nepal—A Qualitative Exploration of Healthcare Professionals’ Opinions. Pharmacy. 2020; 8(3):131. https://doi.org/10.3390/pharmacy8030131
Chicago/Turabian StyleSapkota, Sujata, Jo-anne E. Brien, and Parisa Aslani. 2020. "Diabetes-Related Healthcare Services in Nepal—A Qualitative Exploration of Healthcare Professionals’ Opinions" Pharmacy 8, no. 3: 131. https://doi.org/10.3390/pharmacy8030131
APA StyleSapkota, S., Brien, J. -a. E., & Aslani, P. (2020). Diabetes-Related Healthcare Services in Nepal—A Qualitative Exploration of Healthcare Professionals’ Opinions. Pharmacy, 8(3), 131. https://doi.org/10.3390/pharmacy8030131