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Engaging GPs in insulin therapy initiation: a qualitative study evaluating a support program in the Belgian context

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...

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Autores principales: Sunaert, Patricia, Willems, Sara, Feyen, Luc, Bastiaens, Hilde, De Maeseneer, Jan, Jenkins, Lut, Nobels, Frank, Samyn, Emmanuel, Vandekerckhove, Marie, Wens, Johan, De Sutter, An
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236553/
https://www.ncbi.nlm.nih.gov/pubmed/25145469
http://dx.doi.org/10.1186/1471-2296-15-144
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author Sunaert, Patricia
Willems, Sara
Feyen, Luc
Bastiaens, Hilde
De Maeseneer, Jan
Jenkins, Lut
Nobels, Frank
Samyn, Emmanuel
Vandekerckhove, Marie
Wens, Johan
De Sutter, An
author_facet Sunaert, Patricia
Willems, Sara
Feyen, Luc
Bastiaens, Hilde
De Maeseneer, Jan
Jenkins, Lut
Nobels, Frank
Samyn, Emmanuel
Vandekerckhove, Marie
Wens, Johan
De Sutter, An
author_sort Sunaert, Patricia
collection PubMed
description 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
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spelling pubmed-42365532014-11-19 Engaging GPs in insulin therapy initiation: a qualitative study evaluating a support program in the Belgian context Sunaert, Patricia Willems, Sara Feyen, Luc Bastiaens, Hilde De Maeseneer, Jan Jenkins, Lut Nobels, Frank Samyn, Emmanuel Vandekerckhove, Marie Wens, Johan De Sutter, An BMC Fam Pract Research Article 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 BioMed Central 2014-08-21 /pmc/articles/PMC4236553/ /pubmed/25145469 http://dx.doi.org/10.1186/1471-2296-15-144 Text en Copyright © 2014 Sunaert et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Sunaert, Patricia
Willems, Sara
Feyen, Luc
Bastiaens, Hilde
De Maeseneer, Jan
Jenkins, Lut
Nobels, Frank
Samyn, Emmanuel
Vandekerckhove, Marie
Wens, Johan
De Sutter, An
Engaging GPs in insulin therapy initiation: a qualitative study evaluating a support program in the Belgian context
title Engaging GPs in insulin therapy initiation: a qualitative study evaluating a support program in the Belgian context
title_full Engaging GPs in insulin therapy initiation: a qualitative study evaluating a support program in the Belgian context
title_fullStr Engaging GPs in insulin therapy initiation: a qualitative study evaluating a support program in the Belgian context
title_full_unstemmed Engaging GPs in insulin therapy initiation: a qualitative study evaluating a support program in the Belgian context
title_short Engaging GPs in insulin therapy initiation: a qualitative study evaluating a support program in the Belgian context
title_sort engaging gps in insulin therapy initiation: a qualitative study evaluating a support program in the belgian context
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236553/
https://www.ncbi.nlm.nih.gov/pubmed/25145469
http://dx.doi.org/10.1186/1471-2296-15-144
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