BACKGROUND: Insulin is effective at lowering blood glucose, and most people with type 2 diabetes need insulin within 10 years of diagnosis. However, initiating insulin is often delayed in general practice. This study explores barriers and enablers to insulin initiation in general practice. METHOD: A qualitative study using semistructured, in-depth interviews. Ten general practitioners, four diabetes nurse educators and 12 patients were interviewed. Participants were purposively selected and recruited through snowballing. Data analysis drew on the Normalisation Process Model framework. RESULTS: The understanding of the primary aim of diabetes care and its context (improving pathophysiology, complex multimorbidity, the patient-doctor relationship, impact of living with the condition) was important. There was disagreement and uncertainty about whose role it is to initiate insulin. It was also important whether insulin initiation was conceptualised as a simple, protocol driven intervention, or as a complex and demanding addition to an overwhelming clinical picture. DISCUSSION: Insulin initiation seems more likely if the multiple perspectives on the primary aim of clinical care are acknowledged, and if roles are explicitly discussed and clarified.
BACKGROUND:Insulin is effective at lowering blood glucose, and most people with type 2 diabetes need insulin within 10 years of diagnosis. However, initiating insulin is often delayed in general practice. This study explores barriers and enablers to insulin initiation in general practice. METHOD: A qualitative study using semistructured, in-depth interviews. Ten general practitioners, four diabetes nurse educators and 12 patients were interviewed. Participants were purposively selected and recruited through snowballing. Data analysis drew on the Normalisation Process Model framework. RESULTS: The understanding of the primary aim of diabetes care and its context (improving pathophysiology, complex multimorbidity, the patient-doctor relationship, impact of living with the condition) was important. There was disagreement and uncertainty about whose role it is to initiate insulin. It was also important whether insulin initiation was conceptualised as a simple, protocol driven intervention, or as a complex and demanding addition to an overwhelming clinical picture. DISCUSSION: Insulin initiation seems more likely if the multiple perspectives on the primary aim of clinical care are acknowledged, and if roles are explicitly discussed and clarified.
Authors: Irene D Blackberry; John S Furler; Louise E Ginnivan; Hanan Derraz; Alicia Jenkins; Neale Cohen; James D Best; Doris Young; Danny Liew; Glenn Ward; Jo-Anne Manski-Nankervis; David N O'Neal Journal: BMC Fam Pract Date: 2014-05-03 Impact factor: 2.497
Authors: Patricia Sunaert; Sara Willems; Luc Feyen; Hilde Bastiaens; Jan De Maeseneer; Lut Jenkins; Frank Nobels; Emmanuel Samyn; Marie Vandekerckhove; Johan Wens; An De Sutter Journal: BMC Fam Pract Date: 2014-08-21 Impact factor: 2.497
Authors: Gary Deed; Gary Kilov; Patrick Phillips; Anita Sharma; Stephen Leow; Ian Arthur; John Barlow; Mark Kennedy Journal: Diabetes Ther Date: 2016-02-18 Impact factor: 2.945