[Perceived difficulties among primary care physicians for the prescription of insulin for diabetic patients].
BACKGROUND
Type 2 Diabetes Mellitus is not always treated successfully, in part due to the difficulties perceived by the medical community about the use of insulin.


OBJECTIVE
To identify the constraints perceived by primary care physicians (PCPs) in the prescription and use of insulin.


METHODS
Six PCPs were subjected to a semi-structured interview about self-perceived management difficulties, behaviors and beliefs on the use of insulin among diabetics. According to their responses a questionnaire about the subject was devised and PCPs were invited by e-mail to answer it.


RESULTS
There were 88 replies and 48% of respondents recognized to have management deficiencies in at least one aspect of insulin prescription. The most common deficiencies were determining the type of insulin and treatment of complications. The perceived difficulties were lack of training (58.0%), lack of medical hours (46.6%), lack of communication with specialists (46.6%), lack of reactive strips for capillary blood glucose determination (43.2%) and rotation of doctors (40.9%). The most common behaviors towards patients reluctant to use insulin were persuasion (83.0%), education and supervisión (63.6%) and signature of an ad-hoc document (38.6%). Ninety percent considered that timely use of insulin is more beneficial than its prescription as a last resort and 94.3% did not consider that insulin should be prescribed by a specialist.


CONCLUSIONS
A significant percentage of physicians do not trust their own knowledge about insulin prescription. These professionals should receive training in not only technical aspects of prescribing insulin, but also in the psychological and persuasión strategies. There is willingness among PCPs to prescribe insulin.
Lenz Alcayaga
Rony
R
Escuela de Salud Pública, Universidad de de Chile. rlenz@lenz.cl
Ramírez
Jorge
J
Gac
Rayén
R
Lorca
Eduardo
E
D000328:Adult; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000523:psychology*; D011795:Surveys and Questionnaires
D007004:Hypoglycemic Agents; D007328:Insulin