RT Journal Article
SR Electronic
T1 GPs' approach to insulin prescribing in older patients: a qualitative study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP 569
OP 575
DO 10.3399/bjgp08X319639
VO 58
IS 553
A1 Gina Agarwal
A1 Kalpana Nair
A1 Jarold Cosby
A1 Lisa Dolovich
A1 Mitchell Levine
A1 Janusz Kaczorowski
A1 Chris Butler
A1 Sheri Burns
YR 2008
UL http://bjgp.org/content/58/553/569.abstract
AB 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.