"Walking the talk" in the integration of chronic disease prevention management: dietitians' perspectives regarding diabetes management in adult peritoneal dialysis programs in Ontario

Abstract

Ontario’s Chronic Disease and Prevention Framework (CDPM) is a framework aimed at improving health outcomes and reducing costs. Currently, there is a paucity of data examining diabetes management (DM) in peritoneal dialysis (PD) programs. This study, carried out in 2010-11, describes dietitians’ perspectives regarding DM in PD programs in Ontario. Purposeful sampling of dietitians employed in PD programs (n=18) resulted in a response rate of 86.6%. A web-based survey collected data on demographic characteristics of PD clients, program models, and program-specific data regarding facilitators and barriers to provision of dialysis-specific diabetes education. Statistical analysis was completed and responses to open-ended questions examined using thematic open-coding. Findings suggest three major themes: “walking the CDPM talk”, dietitians as “unrecognized CDPM champions” and “the missing pieces to the CDPM puzzle”. Results suggest that while many dietitians have embraced CDPM, their capacity to fully integrate it into their practices is limited by organizational- and system-level barriers.