August 07, 2018
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PCPs lack sufficient knowledge on insulin use

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A primary care physician’s lack of education on insulin use was one of the barriers to optimal use of insulin among patients with type 2 diabetes, according to data recently published in BMC Family Practice.

“While previous reviews have explored some of the factors related to why insulin use often fails to deliver good outcomes, these factors have not been considered systematically in the context of the management of [type 2 diabetes] in primary care from both the patient and health care professional perspectives collectively,” Kathy Ellis, a research student at King’s College London, and colleagues wrote.

Researchers conducted a thematic synthesis of studies that discussed the experiences and views of 65 primary care physicians, eight practice nurses, three diabetes nurse educators, two endocrinologists and one pharmacist who manage patients with type 2 diabetes. Similar information from 173 adults aged 23 to 90 years with type 2 diabetes was also analyzed.

Barriers among health care professionals

Ellis and colleagues found that the most frequently cited barriers among the health care professionals were lack of education on the technical aspects of insulin and psychosocial factors that influence insulin use; time available for appointments; and the relationship between care and continuity of support

“Given the findings of the patient accounts, this education needs to offer more than the technical aspects of insulin and should include an understanding of the psychosocial factors that may influence insulin use. In relation to time, it may be important to identify the role of other team members in delivering insulin support such as primary care nurses or diabetes specialist nurses supporting the primary care team,” Ellis and colleagues wrote.

Obstacles in health care systems

Researchers also examined obstacles in health care systems regarding insulin use and found these were mostly organizational.

“To ensure that insulin is used optimally in primary care ... the care system needs to be designed to ensure that patients are assessed and followed up by an appropriately trained [health care professional], who can provide continuity in their care experience. The system also needs to consider how to integrate specialist diabetes support to help the primary care teams in their clinical decision making and in building the resources that patients will need to support their insulin use,” they wrote.

Barriers among patients

Ellis and colleagues looked at barriers to insulin use among patients and found that these included experiences using and knowledge regarding the medication, psychosocial factors, self-management skills and underlying beliefs about insulin.

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“The findings suggest that as well as the technical aspect of self-management, the support provided needs to consider the patients’ underlying beliefs, their psychological orientation to insulin and the influence of wider social factors. Addressing the problem of clinical and psychological inertia of the intensification of insulin therapy is key part of the process,” Ellis and colleagues wrote.

Researchers added that addressing the stigma surrounding insulin use, whether the patient wants to manage his or her own insulin use, and the family dynamics surrounding the patient’s use of the medication could also lead to greater uptake among patients. - by Janel Miller

 

Disclosure: The authors declare no relevant financial disclosures.