• Br J Gen Pract · Aug 2008

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

    • Gina Agarwal, Kalpana Nair, Jarold Cosby, Lisa Dolovich, Mitchell Levine, Janusz Kaczorowski, Chris Butler, and Sheri Burns.
    • Department of Family Medicine, McMaster University, Centre for Evaluation of Medicines, St Joseph's Hospital, Hamilton, ON, Canada. gina.agarwal@gmail.com
    • Br J Gen Pract. 2008 Aug 1; 58 (553): 569575569-75.

    BackgroundEvidence 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.AimTo explore the process and rationale for prescribing decisions of GPs when treating older patients with type 2 diabetes.Design Of StudyQualitative individual interviews using a grounded theory approach.SettingPrimary care.MethodA thematic analysis was conducted to identify themes that reflected factors that influence the prescribing of insulin.ResultsTwenty-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.ConclusionGPs' 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.

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