Adjudications and tinkering with care for socially vulnerable patients with type 2 diabetes in general practice

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To analyse the mechanisms at play in the adjudications made by professionals and socially vulnerable patients with type 2 diabetes about their eligibility for care.

Design, setting and subjects
The study included 14 patients and 10 health professionals in seven general practice surgeries in deprived areas in Greater Copenhagen. The study data consist of 17 semi-structured interviews with patients and 22 with health professionals immediately after observation of 23 consultations. Our analytical approach was inspired by Systematic Text Condensation and the concept of ‘candidacy’ for access to health care.

Adjudications of patients not being candidates for services were common, but we also found that both patients and health professionals worked to align the services to the needs of the patients. This could include using services differently than was intended by the providers or by changing routines to make it easier for patients to use the services. We discuss these processes as ‘tinkering’. This usually implies that the best individual solution for the patient is aimed for, and in this study, the best solution sometimes meant not focusing on diabetes.

The study adds to existing knowledge about access to services for socially vulnerable patients by demonstrating that both patients and professionals in general practice engage in tinkering processes to make services work.
TidsskriftScandinavian Journal of Primary Health Care
Udgave nummer2
Sider (fra-til)295-303
Antal sider9
StatusUdgivet - 2024

Bibliografisk note

Funding Information:
The authors would like to thank the patients and the health professionals who kindly participated in the study. They would also like to thank Tværspuljen- Region Hovedstaden, The Vissing Foundation, Læge Sofus Carl Emil Friis og Hustru Olga Friis’ Legat, Praktiserende Lægers Uddannelses- og Udviklingsfond (Danish College of General Practitioners), and the Committee of Multipractice Studies in General Practice for financial support.

Publisher Copyright:
© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

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