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GPs' approach to insulin prescribing in older patients: a qualitative study

Agarwal, Gina, Nair, Kalpana, Cosby, Jarold, Dolovich, Lisa, Levine, Mitchell, Kaczorowski, Janusz, Butler, Christopher Collett and Burns, Sheri 2008. GPs' approach to insulin prescribing in older patients: a qualitative study. British Journal of General Practice (BJGP) 58 (553) , pp. 569-575. 10.3399/bjgp08X319639

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Abstract

Background Evidence suggests that insulin is under-prescribed in older people. Some reasons for this include physician's concerns about potential side-effects or patients' resistance to insulin. In general, however, little is known about how GPs make decisions related to insulin prescribing in older people. Aim To explore the process and rationale for prescribing decisions of GPs when treating older patients with type 2 diabetes. Design of study Qualitative individual interviews using a grounded theory approach. Setting Primary care. Method A thematic analysis was conducted to identify themes that reflected factors that influence the prescribing of insulin. Results Twenty-one GPs in active practice in Ontario completed interviews. Seven factors influencing the prescribing of insulin for older patients were identified: GPs' beliefs about older people; GPs' beliefs about diabetes and its management; gauging the intensity of therapy required; need for preparation for insulin therapy; presence of support from informal or formal healthcare provider; frustration with management complexity; and GPs' experience with insulin administration. Although GPs indicated that they would prescribe insulin allowing for the above factors, there was a mismatch in intended approach to prescribing and self-reported prescribing. Conclusion GPs' rationale for prescribing (or not prescribing) insulin is mediated by both practitioner-related and patient-related factors. GPs intended and actual prescribing varied depending on their assessment of each patient's situation. In order to improve prescribing for increasing numbers of older people with type 2 diabetes, more education for GPs, specialist support, and use of allied health professionals is needed.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Systems Immunity Research Institute (SIURI)
Subjects: R Medicine > R Medicine (General)
Uncontrolled Keywords: insulin, primary health care, qualitative research, type 2 diabetes mellitus
Publisher: Royal College of General Practitioners
ISSN: 0960-1643
Last Modified: 30 Jun 2017 02:27
URI: http://orca-mwe.cf.ac.uk/id/eprint/29482

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