A mixed-method study on the screening practices and barriers to diabetic microvascular complications by general practitioners in community health centers of Xiamen, China

Early screening and management of diabetic microvascular complications are of crucial importance for preventing diabetes progression and improving patient outcomes. This study aimed to assess the current status of screening practices employed by general practitioners (GPs) in community health centers (CHCs) in Xiamen, China, and identify implementation barriers. A mixed quantitative and qualitative method was adopted between March 2023 and January 2024. The quantitative component involved a cross-sectional study using stratified sampling in nine CHCs from two Xiamen districts. The qualitative component employed semi-structured interviews with participants recruited through purposive sampling. Data analysis used a thematic step-by-step approach. A total of 93 GPs participated in the quantitative study, with a practice score of 45.9 ± 15.4/100. Higher attitude scores (β = 0.802, P < 0.001) and managing more diabetic patients (β = 0.032, P = 0.008) were associated with better practice scores. A total of 13 GPs participated in qualitative interviews. Current screening practices in CHCs were characterized by inadequate screening items, non-adherence to guideline-recommended screening frequencies, and lack of sustainable screening. Identified barriers included insufficient attention to screening of GPs and patients, knowledge and skill deficits of GPs, human resource shortages, lack of incentive mechanisms, inadequate screening instruments, and low adherence of patients. Strengthening the training of GPs, providing screening instruments, optimizing the screening process, and enhancing patient education are needed for effective improvement. The screening practices for diabetic microvascular complications among GPs in Xiamen were suboptimal, mainly due to factors associated with workforce constraints, variations in GP capabilities, and limitations in available screening instruments.