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Br J Gen Pract. 2008 Aug;58(553):569-75. doi: 10.3399/bjgp08X319639.

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

Author information

1
Department of Family Medicine, McMaster University, Centre for Evaluation of Medicines, St Joseph's Hospital, Hamilton, ON, Canada. gina.agarwal@gmail.com

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.

PMID:
18682013
PMCID:
PMC2566521
DOI:
10.3399/bjgp08X319639
[Indexed for MEDLINE]
Free PMC Article

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