Aims

To investigate the attitudes and beliefs of primary healthcare practitioners (HCPs) towards initiating insulin therapy for people with type 2 diabetes (T2D) in South Africa.

Methods

A cross-sectional survey was conducted amongst HCPs from 23 clinics. The nurses’ questionnaire was administered by research nurses while doctors completed an online version about their attitudes, beliefs and perceived barriers to initiating insulin.

Results

Of the 73 HCPs surveyed, 68% were nurses and 84% were women. Only 24% of HCPs believed that most patients would eventually need to initiate insulin regardless of their adherence to treatment regimens and 86% preferred to delay insulin therapy. Doctors were reluctant to initiate insulin, citing patient-related reasons such as low socio-economic level (41%), inability to refrigerate insulin (77%) and inability to self-monitor blood glucose (55%). Doctors mentioned that patient behaviour including not adhering to treatment regimen and appointments (91%) and reluctance to start insulin therapy (82%) influenced their prescription practices. Doctors mentioned that health system factors, including the pressure to see patients quickly (68%) and lack of continuity of care (64%) were barriers to initiating insulin.

Conclusions

Optimising insulin therapy in primary care requires health system changes including promoting person-centred care and continuing training for HCPs.

中文翻译：

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南非初级保健从业者对 2 型糖尿病患者开始使用胰岛素的态度和信念：来自茨瓦内胰岛素项目 (TIP) 的结果

宗旨

调查初级保健从业者 (HCP) 对南非 2 型糖尿病 (T2D) 患者开始胰岛素治疗的态度和信念。

方法

对来自 23 家诊所的 HCP 进行了横断面调查。护士的问卷由研究护士管理，而医生则完成了关于他们的态度、信念和开始使用胰岛素的障碍的在线版本。

结果

在接受调查的 73 名 HCP 中，68% 是护士，84% 是女性。只有 24% 的 HCP 认为大多数患者最终需要开始胰岛素治疗，而不管他们是否坚持治疗方案，86% 的人更愿意推迟胰岛素治疗。医生不愿开始使用胰岛素，理由是与患者相关的原因，例如社会经济水平低 (41%)、无法冷藏胰岛素 (77%) 和无法自我监测血糖 (55%)。医生提到，包括不遵守治疗方案和预约 (91%) 以及不愿开始胰岛素治疗 (82%) 在内的患者行为影响了他们的处方实践。医生提到卫生系统因素，包括快速看病的压力 (68%) 和缺乏连续性护理 (64%) 是启动胰岛素治疗的障碍。

结论

优化初级保健中的胰岛素治疗需要改变卫生系统，包括促进以人为本的护理和对 HCP 的持续培训。