| Personalized care |
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| • Care environment |
With [the educators] at our doctor’s in the same place … we can arrange our appointment the same time, right after our family doctor, then we go right there and we get rid of it all at one time (Patient 1) It actually works better because I’ve got the results in and then they … talk to me about it. If they see anything that needs to be brought to the doctor’s attention then usually I have a doctor’s appointment on that same day so then they can bring things up. So, if it is a case where they might think that I should change my medication or whatever then they can bring that up to the doctor. So after I see the nurse and the dietitian then I see my doctor (Patient 13) You see the doctor, and after that you see the nurse, and [after] the nurse you see the dietitian, 3 in 1 ... yes, it’s very convenient and it’s very helpful for any patient (Patient 16)
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| • Shared decision making |
Because we do work as a team … it feels like it’s a team; definitely a team working on your health care (Patient 15) Well that’s usually what we do ... we usually evaluate where I [am] .... By the end of the session I’m setting a series of goals. And then in our next session, have I attained these goals? If not, we talk about why it didn’t happen and what we can do to ... try to get back on track, or try to hit these goals. And then … we go through that and … at the end of every session ... here’s my next set of goals (Patient 15) The … dietitian never [said] “You have to.” The … dietitian [said] “Yes, but you know if you get … that … and do it … like that ….” She never [said] “You have to stop this” or “stop that” (Patient 11) I think it is more collaborative. They look at my numbers, they talk to me about them, they ask me why. I’ll explain stuff and we come up with a plan together (Patient 13)
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| • Preference for one-on-one care |
[She] has helped me out quite a bit with the insulin and she takes her time, she doesn’t rush me out of the office. She explains things to me that I’m confused on, like ... the insulin (Patient 4) I found, at my group sessions, it was people who had different needs, so ... everything seemed very generalized, not very specific (Patient 15) Sometimes you might have things that you want to talk about that you don’t necessarily want [a] bunch of people there for (Patient 22) It keeps you motivated and you look forward to it …. When they did it at the diabetic centre there were about 20 [or] 30 people but then a lot of people wouldn’t … ask questions when there’s so many people. So here, one-on-one is good (Patient 14) It’s like reading instructions if you’re trying to put something together. You can read it and reread it and you still have no idea what you’re doing. But with them and the staff, they take the time to explain it; to show it to you (Spouse of Patient 2) Knowing what it actually does to your body, knowing ways to change it, knowing ways that you could avoid things or reverse things—that is more assessable on a one-to-one basis (Patient 17)
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| Patient-provider relationship |
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| • Respect |
For one thing, they respect my time so I don’t have to [wait] …. [At the] other clinic I waited an hour (Patient 17) They didn’t treat me as somebody that was ... stupid, not [like] “OK … why are you not looking after yourself?” They … weren’t degrading by any means: “We’re here to help you” …. They’re not judgmental (Patient 6) It’s hard to work with my diet and keep blood sugars down … and they’re trying their best to work around it. [The educator suggested to] take yogurt at this time, add [a] banana to smoothies for my food replacement .... (Patient 16) I eat a lot of rice … for example. That’s my culture, like we eat a lot of rice and peas and stuff like that .... I wasn’t aware of how ... devastating the amount that I eat [is]. So it’s more about portion control and seeing how that’s really affecting me (Patient 17)
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| • Supportive interaction |
Both of them were friendly … and … wanted to listen and … get me … answers to the questions I had (Patient 8) You need the support; their support. You need the help …. There’s not a diabetic person out there that doesn’t need the support (Patient 5) They were very understanding and helped me sort of adjust to that [diabetes]. So it seems more comfortable now than it did in the beginning (Patient 10) [They] not only [give] you the medications, they tell you what to do about it, and how to [use it]. The doctor give[s] you the medication, right …. I like my family doctor but he cannot talk to you all the time …. That’s why he refers you to [the] team who have the time [to] explain ... everything. He cannot keep track of it [all], so you cannot come to him every day …. The team is like a big support group, but when I see him he reads the results because he has a set of notes. So he knows what’s going on, too. He bases his decisions on them, too. This is [a] very good, supportive team (Patient 16) It’s quite a good team in terms of the information being consistent (Patient 13) I find [that] they base their decisions on each other … my doctor, he bases decisions on how to increase [medications], because he talked to her and ... she recommended that (Patient 16)
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| • Facilitating patient engagement |
You make little … changes, like … I don’t drink juices anymore. I’ll eat the food rather, and I’ll … drink water …. I find that’s something that I’ve changed and I don’t put cream or sugar in my coffee anymore, I just put milk in. Sometimes these little things make a difference in the long run, and … I didn’t find [it] that hard to change (Patient 22) She has been very good at breaking down the medication. We’ve talked expansively about the best times to take medication, switching things around to see how they work …. She suggested that I split the Diamicron [gliclazide] [into] 2 in the morning and 2 in the evening, along with the other diabetic medications, and it actually helped lower the morning number (Patient 13) Because of what I have learned and my confidence in myself in being able to manage my diabetes, I think that … other people should be doing this (Patient 20) I feel a lot better about [diabetes] now because I know what I can do (Patient 21) I’m now better at managing it. The diabetes is not better, but I’m now better managing it (Patient 18) We’re learning everything all the time and it is important because, again, we didn’t know about the insulin. We don’t know what else is out there that could be more beneficial for [Patient 2]. And for myself because, again, I live with him (Spouse of Patient 2) I know what to do. I know everything about [diabetes], blood sugar, carbohydrates and glucose, insulin … when to take it. [What to do] if I am low, or if I am high. I check my blood sugar. I look [at] what I eat. I usually … make sure about carbohydrate[s]. When I buy stuff … I read the label. I count the carbohydrate[s]. I like that (Patient 19)
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