title: GPs' approach to insulin prescribing in older patients: a qualitative study.
abstract: BACKGROUND
  Evidence 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.
  
  
  OBJECTIVE
  To explore the process and rationale for prescribing decisions of GPs when treating older patients with type 2 diabetes.
  
  
  METHODS
  Qualitative individual interviews using a grounded theory approach.
  
  
  METHODS
  Primary care.
  
  
  METHODS
  A thematic analysis was conducted to identify themes that reflected factors that influence the prescribing of insulin.
  
  
  RESULTS
  Twenty-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.
  
  
  CONCLUSIONS
  GPs' 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.
authors.affiliation: Department of Family Medicine, McMaster University, Centre for Evaluation of Medicines, St Joseph's Hospital, Hamilton, ON, Canada. gina.agarwal@gmail.com
authors.forename: Gina
authors.initials: G
authors.lastname: Agarwal
authors.forename: Kalpana
authors.initials: K
authors.lastname: Nair
authors.forename: Jarold
authors.initials: J
authors.lastname: Cosby
authors.forename: Lisa
authors.initials: L
authors.lastname: Dolovich
authors.forename: Mitchell
authors.initials: M
authors.lastname: Levine
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
authors.forename: Chris
authors.initials: C
authors.lastname: Butler
authors.forename: Sheri
authors.initials: S
authors.lastname: Burns
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005194:Family Practice / Q000193:education / Q000592:standards*; D005260:Female; D006299:Health Services for the Aged / Q000592:standards; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin