Primary care for diabetes mellitus: perspective from older patients

BACKGROUND Care of diabetes mellitus in the elderly requires an additional perspective to take into account impaired cognitive function, physical function, low level of education, and difficulty making lifestyle changes. Existing services tend to be driven by the views of tertiary and secondary care staff, rather than those of primary care staff and elderly patients. This study aimed to explore the attitudes and preferences of elderly patients with diabetes mellitus towards primary care (clinical care and community program). METHOD Elderly patients with diabetes mellitus aged 60 years or above were recruited from governmental diabetes mellitus clinics and diabetes mellitus specific community centers. Three focus group discussions of 14 diabetic elderly patients were conducted and their perspectives on the new service model were assessed. Participants were interviewed according to an open-ended discussion guide which includes the following items: comments on existing clinic follow up and community program, motivation for joining the community program, and suggestions on further clinical services and community service program development. RESULTS Incapability of the current health service to address their special needs was a common concern in three focus group discussions. The majority highlighted the benefits of the new service program, that is, self-care knowledge and skill, attitudes to living with diabetes mellitus, and supportive network. Key facilitators included experiential learning, a group discussion platform, and goal setting with patients. CONCLUSIONS This study is the first qualitative study to explore the views of elderly diabetic patients' on their self-care needs. Elderly people with diabetes mellitus in this study identified bad experiences of clinical follow-up; benefit from the community program; and recommendations for the future development of primary care. Study findings revealed a number of discrepancies between elderly diabetic patients' needs and existing health services in Hong Kong. The study findings provide health practitioners, researchers and educators with an additional perspective on the provision of quality of care for elderly diabetic patients in the community.