title: Insulin in general practice - barriers and enablers for timely initiation.
abstract: BACKGROUND
  Insulin is effective at lowering blood glucose, and most people with type 2 diabetes need insulin within 10 years of diagnosis. However, initiating insulin is often delayed in general practice. This study explores barriers and enablers to insulin initiation in general practice.
  
  
  METHODS
  A qualitative study using semistructured, in-depth interviews. Ten general practitioners, four diabetes nurse educators and 12 patients were interviewed. Participants were purposively selected and recruited through snowballing. Data analysis drew on the Normalisation Process Model framework.
  
  
  RESULTS
  The understanding of the primary aim of diabetes care and its context (improving pathophysiology, complex multimorbidity, the patient-doctor relationship, impact of living with the condition) was important. There was disagreement and uncertainty about whose role it is to initiate insulin. It was also important whether insulin initiation was conceptualised as a simple, protocol driven intervention, or as a complex and demanding addition to an overwhelming clinical picture.
  
  
  CONCLUSIONS
  Insulin initiation seems more likely if the multiple perspectives on the primary aim of clinical care are acknowledged, and if roles are explicitly discussed and clarified.
authors.affiliation: Department of General Practice, University of Melbourne, Victoria. j.furler@unimelb.edu.au
authors.forename: John
authors.initials: J
authors.lastname: Furler
authors.forename: Ondine
authors.initials: O
authors.lastname: Spitzer
authors.forename: Doris
authors.initials: D
authors.lastname: Young
authors.forename: James
authors.initials: J
authors.lastname: Best
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D058006:General Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007407:Interviews as Topic; D024802:Nurse's Role; D010819:Physician's Role; D036301:Qualitative Research; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin