Date of Award

Fall 2011

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Health Research Methodology

Supervisor

Janusz Kaczorowski

Co-Supervisor

Hertzel Gerstein

Language

English

Committee Member

Steve Hanna

Abstract

This thesis describes some of the prominent issues facing primary care practitioners regarding diabetes care. Type 2 diabetes (T2DM) is a common metabolic disturbance among Canadians, now reaching worldwide epidemic proportions. Alarmingly, diabetes prevalence is expected to increase significantly in future years. This increase in diabetes will lead to corresponding increases in the rates of complications, which place a burden on the health care system. However, interventions could prevent or delay T2DM and thus decrease morbidity and mortality associated with its complications if individuals at risk of developing diabetes are detected early.

The first paper describes a systematic review to determine the effectiveness of T2DM screening methods using community or family practice-based systematic screening approaches compared to opportunistic family practice-based approaches. The second paper describes a novel community health initiative, the Community Health Awareness of Diabetes (CHAD) Program. It reports participant characteristics and satisfaction with the community-wide diabetes awareness demonstration project. The third paper examines whether the CHAD program was effective in increasing detection of diabetes. As routine diabetes care remains largely a family practice activity, and something that all family doctors participate in, the fourth paper reports on the current state of diabetes care in 96 Ontario family practices.. The final paper reports the findings of a qualitative study examining family physicians’ approach to insulin prescribing in older patients. Current prevalence figures estimate that 16% of people over 65 years have diabetes and family practitioners look after these individuals and their diabetes.

Finally, recommendations are made as to how screening and care for diabetes in primary care could be improved. In summary, policies supporting community initiatives partnering with primary healthcare should be promoted in an effort to share the burden of screening for diabetes, and also to target appropriate screening to populations that need it the most.

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