PMID- 25145469
OWN - NLM
STAT- MEDLINE
DCOM- 20150330
LR  - 20211021
IS  - 1471-2296 (Electronic)
IS  - 1471-2296 (Linking)
VI  - 15
DP  - 2014 Aug 21
TI  - Engaging GPs in insulin therapy initiation: a qualitative study evaluating a 
      support program in the Belgian context.
PG  - 144
LID - 10.1186/1471-2296-15-144 [doi]
AB  - BACKGROUND: A program supporting the initiation of insulin therapy in primary 
      care was introduced in Belgium, as part of a larger quality improvement project 
      on diabetes care. This paper reports on a study exploring factors influencing the 
      engagement of general practitioners (GPs) in insulin therapy initiation (research 
      question 1) and exploring factors relevant for future program development 
      (research question 2). METHODS: We have used semi-structured interviews to answer 
      the first research question: two focus group interviews with GPs who had at least 
      one patient in the insulin initiation program and 20 one-to-one interviews with 
      GPs who were not regular users of the overall support program in the region. To 
      explore factors relevant for future program development, the data from the GPs 
      were triangulated with data obtained from individual interviews with patients 
      (n = 10), the diabetes nurse educator (DNE) and the specialist involved in the 
      program, and data extracted from meeting reports evaluating the insulin 
      initiation support program. RESULTS: We found differences between GPs engaged and 
      those not engaged in insulin initiation in attitude, subjective norm and 
      perceived behavioural control regarding insulin initiation. In general the 
      support program was evaluated in a positive way by users of the program. Some 
      aspects need further consideration: job boundaries between the DNE and GPs, job 
      boundaries between GPs and specialists, protocol adherence and limited case load. 
      CONCLUSION: The study shows that the transition of insulin initiation from 
      secondary care to the primary care setting is a challenge. Although a support 
      program addressing known barriers to insulin initiation was provided, a 
      substantial number of GPs were reluctant to engage in this aspect of care. 
      Important issues for future program development are: an interdisciplinary 
      approach to job clarification, a dynamic approach to the integration of expertise 
      in primary care and feedback on protocol adherence. TRIAL REGISTRATION: 
      ClinicalTrials.gov Identifier: NCT00824499.
FAU - Sunaert, Patricia
AU  - Sunaert P
AD  - Department of General Practice and Primary Health Care, Ghent University, De 
      Pintelaan, 185, 9000 Ghent, Belgium. patricia.sunaert@ugent.be.
FAU - Willems, Sara
AU  - Willems S
FAU - Feyen, Luc
AU  - Feyen L
FAU - Bastiaens, Hilde
AU  - Bastiaens H
FAU - De Maeseneer, Jan
AU  - De Maeseneer J
FAU - Jenkins, Lut
AU  - Jenkins L
FAU - Nobels, Frank
AU  - Nobels F
FAU - Samyn, Emmanuel
AU  - Samyn E
FAU - Vandekerckhove, Marie
AU  - Vandekerckhove M
FAU - Wens, Johan
AU  - Wens J
FAU - De Sutter, An
AU  - De Sutter A
LA  - eng
SI  - ClinicalTrials.gov/NCT00824499
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140821
PL  - England
TA  - BMC Fam Pract
JT  - BMC family practice
JID - 100967792
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Attitude of Health Personnel
MH  - *Attitude to Health
MH  - Belgium
MH  - Diabetes Mellitus, Type 2/*drug therapy/psychology
MH  - Female
MH  - General Practice/*methods
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Insulin/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - *Practice Patterns, Physicians'
MH  - Primary Health Care/*methods
MH  - Qualitative Research
PMC - PMC4236553
EDAT- 2014/08/26 06:00
MHDA- 2015/03/31 06:00
PMCR- 2014/08/21
CRDT- 2014/08/23 06:00
PHST- 2014/03/05 00:00 [received]
PHST- 2014/08/14 00:00 [accepted]
PHST- 2014/08/23 06:00 [entrez]
PHST- 2014/08/26 06:00 [pubmed]
PHST- 2015/03/31 06:00 [medline]
PHST- 2014/08/21 00:00 [pmc-release]
AID - 1471-2296-15-144 [pii]
AID - 10.1186/1471-2296-15-144 [doi]
PST - epublish
SO  - BMC Fam Pract. 2014 Aug 21;15:144. doi: 10.1186/1471-2296-15-144.