title: Prescribing attitudes, behaviors and opinions regarding metformin for patients with diabetes: a focus group study.
abstract: BACKGROUND
  The purpose of this study was to identify the reasons why metformin prescribing is suboptimal.
  
  
  METHODS
  Two semi-structured focus groups with attitudinal questionnaires and a brief educational presentation were held in two US cities. Participants included providers (physicians, pharmacists, midlevel practitioners) caring for patients with type 2 diabetes mellitus (T2DM) in an ambulatory setting. Outcome measures included provider attitudes, behaviors and opinions regarding the use of metformin.
  
  
  RESULTS
  Participants identified three main themes influencing the use of metformin, including the appropriate timing of metformin initiation, known risks associated with metformin, and procedures to manage safety concerns and mitigate adverse effects associated with metformin. Participant prescribing behaviors of metformin were not consistent with the best available evidence in the settings of renal insufficiency, heart failure, hepatic dysfunction, alcohol use, and lactic acidosis. With minimal education, provider prescribing behaviors appeared to change by the end of the focus group to align more closely with the best available evidence.
  
  
  CONCLUSIONS
  Provider attitudes, behaviors and opinions regarding the use of metformin for T2DM reveals the need for further education to improve appropriate use of metformin. Educational interventions should target prescribing behaviors and opinions identified to be inconsistent with the evidence.
authors: Schools of Pharmacy and Medicine, University of Colorado Anschutz Medical Campus, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA.
authors: Katy E
authors: KE
authors: Trinkley
authors: Department of Pharmacy Practice, University of Arizona, Tucson, AZ, USA.
authors: Daniel C
authors: DC
authors: Malone
authors: Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
authors: Jennifer A
authors: JA
authors: Nelson
authors: Department of Family Medicine, University of Colorado, Aurora, CO, USA.
authors: Joseph J
authors: JJ
authors: Saseen