title: How do health care professionals assess patients when initiating insulin therapy? A qualitative study.
abstract: OBJECTIVE
  To explore how health care professionals (HCPs) assess patients when initiating insulin therapy in type 2 diabetes.
  
  
  METHODS
  Focus group discussions and in-depth interviews were conducted with 41 health care professionals in Malaysia in 2010-2011. A semi-structured topic guide was used for the interview. The interviews were transcribed verbatim and analysed using the Nvivo9 software based on a thematic approach.
  
  
  RESULTS
  HCPs were less likely to initiate insulin therapy in patients who were older, with irregular dietary patterns and poor financial status. They also assessed patients' knowledge, views and misconceptions of insulin. However, there was a variation in how doctors assessed patients' comorbidities before starting insulin therapy. Medical officers were more likely to initiate insulin therapy in patients with comorbidities and complications, whereas family medicine specialists were more cautious. In addition, most HCPs considered patients' psychosocial status, including self-care ability, social support and quality of life.
  
  
  CONCLUSIONS
  HCPs' assessment of patients' need to start insulin therapy depends on their perception rather than objective evaluation of patients' background, knowledge, perception and abilities. The background and the type of practice of HCPs influence their assessment.
authors: Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia. Electronic address: yein@upm.edu.my.
authors: Ping Yein
authors: PY
authors: Lee
authors: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
authors: Yew Kong
authors: YK
authors: Lee
authors: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
authors: Ee Ming
authors: EM
authors: Khoo
authors: Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
authors: Chirk Jenn
authors: CJ
authors: Ng
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D005247:Feeding Behavior; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007182:Income; D007328:Insulin / Q000627:therapeutic use*; D007407:Interviews as Topic; D008019:Life Style; D008296:Malaysia; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D011788:Quality of Life; D012307:Risk Factors; D012648:Self Care; D012944:Social Support; D013038:Specialization; D013997:Time Factors; D061665:Time-to-Treatment
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Insulin therapy initiation; Physicians’ medical decision; Type 2 diabetes