Diabetic patients’ journey in healthcare: a multi-method, multi-center study proposal

Abstract

Background: Diabetes Mellitus (DM) requires patients to adhere to several treatments, diagnostic examinations and admit to different health professionals. Thus patients face a complicated journey through the healthcare system. This journey might be affected by factors such as socio-cultural characteristics and healthcare services. One of the core competencies of family medicine, continuity of care, stands as a cornerstone to guide the patients in this complicated journey and is associated with decreased emergency department attendance, hospitalization, and mortality. Research questions: How can we describe diabetic patients’ journey in health systems with different integration levels by using existing data and operational research methods? How is this journey experienced by the patients? Does continuity of care facilitate this journey? Method: This multi-method, multi-country study will include adult patients with type 2 DM. Patients will be recruited by primary care physicians from participating countries by purposive sampling to ensure maximum variability in terms of age, literacy, gender and diabetes age. The quantitative part will be conducted as follows. Data will be retracted from electronic medical records. Process mining will be applied to describe the paths of patients in the system. This method uses event logs to describe the processes, check conformance to defined processes and analyze processes by defining cycle and waiting times at various stages and identifying bottlenecks. Stastistical analysis will be performed via R package. The level of continuity of primary care will be calculated using the Usual Provider Continuity index in which the numerator is the number of visits with “own” physician for a year and the denominator is the total number of visits with other physicians for the same year. The qualitative part will explore the behaviour and experiences of patients in their regular interactions with primary care physicians. For this, a phenomenological approach using semi-structured interviews is proposed.