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Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa

BACKGROUND: Type 2 diabetes (T2DM) is a leading cause of mortality in South Africa and resistance to the use of insulin is common. This study aimed to explore factors that influence the initiation of insulin in patients with T2DM in primary care facilities in Cape Town, South Africa. METHODS: An exp...

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Autores principales: Mathose, Tasunungurwa T., Mash, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AOSIS 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9982463/
https://www.ncbi.nlm.nih.gov/pubmed/36861914
http://dx.doi.org/10.4102/safp.v65i1.5656
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author Mathose, Tasunungurwa T.
Mash, Robert
author_facet Mathose, Tasunungurwa T.
Mash, Robert
author_sort Mathose, Tasunungurwa T.
collection PubMed
description BACKGROUND: Type 2 diabetes (T2DM) is a leading cause of mortality in South Africa and resistance to the use of insulin is common. This study aimed to explore factors that influence the initiation of insulin in patients with T2DM in primary care facilities in Cape Town, South Africa. METHODS: An exploratory descriptive qualitative study was conducted. Seventeen semi-structured interviews were held with patients eligible for insulin, on insulin and primary care providers. Participants were selected by maximum variation purposive sampling. Data were analysed using the framework method in Atlas-ti. RESULTS: Factors related to the health system, service delivery, clinical care and patients. Systemic issues related to the required inputs of workforce, educational materials, and supplies. Service delivery issues related to workload, poor continuity and parallel coordination of care. Clinical issues related to adequate counselling. Patient factors included a lack of trust, concerns about injections, impact on lifestyle and disposal of needles. CONCLUSION: Although resource constraints are likely to remain, district and facility managers can improve supplies, educational materials, continuity and coordination. Counselling must be improved and may require innovative alternative approaches to support clinicians who face high number of patients. Alternative approaches using group education, telehealth and digital solutions should be considered. CONTRIBUTION: This study identified key factors influencing insulin initiation in patients with T2DM in primary care. These can be addressed by those responsible for clinical governance, service delivery and in further research.
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spelling pubmed-99824632023-03-04 Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa Mathose, Tasunungurwa T. Mash, Robert S Afr Fam Pract (2004) Original Research BACKGROUND: Type 2 diabetes (T2DM) is a leading cause of mortality in South Africa and resistance to the use of insulin is common. This study aimed to explore factors that influence the initiation of insulin in patients with T2DM in primary care facilities in Cape Town, South Africa. METHODS: An exploratory descriptive qualitative study was conducted. Seventeen semi-structured interviews were held with patients eligible for insulin, on insulin and primary care providers. Participants were selected by maximum variation purposive sampling. Data were analysed using the framework method in Atlas-ti. RESULTS: Factors related to the health system, service delivery, clinical care and patients. Systemic issues related to the required inputs of workforce, educational materials, and supplies. Service delivery issues related to workload, poor continuity and parallel coordination of care. Clinical issues related to adequate counselling. Patient factors included a lack of trust, concerns about injections, impact on lifestyle and disposal of needles. CONCLUSION: Although resource constraints are likely to remain, district and facility managers can improve supplies, educational materials, continuity and coordination. Counselling must be improved and may require innovative alternative approaches to support clinicians who face high number of patients. Alternative approaches using group education, telehealth and digital solutions should be considered. CONTRIBUTION: This study identified key factors influencing insulin initiation in patients with T2DM in primary care. These can be addressed by those responsible for clinical governance, service delivery and in further research. AOSIS 2023-02-28 /pmc/articles/PMC9982463/ /pubmed/36861914 http://dx.doi.org/10.4102/safp.v65i1.5656 Text en © 2023. The Authors https://creativecommons.org/licenses/by/4.0/Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
spellingShingle Original Research
Mathose, Tasunungurwa T.
Mash, Robert
Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa
title Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa
title_full Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa
title_fullStr Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa
title_full_unstemmed Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa
title_short Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa
title_sort factors influencing insulin initiation in primary care facilities in cape town, south africa
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9982463/
https://www.ncbi.nlm.nih.gov/pubmed/36861914
http://dx.doi.org/10.4102/safp.v65i1.5656
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