In search of patient-centred care in middle income countries: The experience of diabetes care in the former Soviet Union

- For the first time, we examine barriers to patient-centred care in the former USSR.
- We use diabetes as a tracer condition, examining patient and provider perspectives.
- Despite strengthened primary care, patients often go straight to specialists.
- Care for patients with diabetes is fragmented and not integrated into general care.
- Health systems struggle to provide care responding to patient needs and expectations.

In this study we apply the principles of patient-centred care to assess how health systems in middle income countries shape the experiences of patients with a common chronic disease and their care providers. We conducted semi-structured interviews with patients with diabetes, health professionals and key informants. We selected interviewees by purposive and snowball sampling. In total 340 respondents were interviewed in five countries: Armenia, Belarus, Moldova, Russia and Ukraine. Data were analysed according to a coding framework that was developed by three researchers, who then uncovered salient themes, similarities and differences between the five countries. Access to and consistent use of services was hampered by the lack of coordination and the financial weaknesses in the health systems. In many cases, lack of external support for individual patients left friends and family as the main providers of support. Patients were not expected to have a say or challenge the decisions concerning their treatment. Our study suggests the need for a radically different way of delivering care for people with diabetes and, by extension, other chronic diseases. Reforms should focus on improving self-management, the coordination of care, involving patients in decisions about their care, and providing emotional and practical support for patients.