Roles and relationships between health professionals involved in insulin initiation for people with type 2 diabetes in the general practice setting: a qualitative study drawing on relational coordination theory.
BACKGROUND
The majority of care for people with type 2 diabetes occurs in general practice, however when insulin initiation is required it often does not occur in this setting or in a timely manner and this may have implications for the development of complications. Increased insulin initiation in general practice is an important goal given the increasing prevalence of type 2 diabetes and a relative shortage of specialists. Coordination between primary and secondary care, and between medical and nursing personnel, may be important in achieving this. Relational coordination theory identifies key concepts that underpin effective interprofessional work: communication which is problem solving, timely, accurate and frequent and relationships between professional roles which are characterized by shared goals, shared knowledge and mutual respect. This study explores roles and relationships between health professionals involved in insulin initiation in order to gain an understanding of factors which may impact on this task being carried out in the general practice setting.


METHODS
21 general practitioners, practice nurses, diabetes nurse educators and physicians were purposively sampled to participate in a semi-structured interview. Transcripts of the interviews were analysed using framework analysis.


RESULTS
There were four closely interlinked themes identified which impacted on how health professionals worked together to initiate people with type 2 diabetes on insulin: 1. Ambiguous roles; 2. Uncertain competency and capacity; 3. Varying relationships and communication; and 4. Developing trust and respect.


CONCLUSIONS
This study has shown that insulin initiation is generally recognised as acceptable in general practice. The role of the DNE and practice nurse in this space and improved communication and relationships between health professionals across organisations and levels of care are factors which need to be addressed to support this clinical work. Relational coordination provides a useful framework for exploring these issues.
General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria. jomn@unimelb.edu.au.
Jo-Anne
JA
Manski-Nankervis
John
J
Furler
Irene
I
Blackberry
Doris
D
Young
David
D
O'Neal
Elizabeth
E
Patterson
D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D058006:General Practice; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D007400:Interprofessional Relations; D008297:Male; D009729:Nursing; D010348:Patient Care Team; D024382:Professional Role; D036301:Qualitative Research
D007328:Insulin