Trust, targets and teenagers: the negative impact of the audit culture combined with the medicalisation of adolescence on young people with diabetes

Objective: To examine the value of ‘trust’ in the delivery of patient centred care for young people with Type 1 diabetes. Design: A longitudinal, quantitative study using semi-structured interviews and observation of consultations using the constant comparative method. Setting: Seven clinical centres in three Health Boards in Scotland. Participants: Nineteen health care professionals and 65 young people. Results: Conclusions: Two distinct barriers (the audit culture and medicalisation) interfere with the establishment of long-term reciprocity between health care professionals and young people with diabetes, which diminishes the development of trust based relationships. To improve the reciprocity necessary for maintaining these long-term relationships requires both an appreciation of these barriers and a change in management strategy to nullify their impact.