title: Barriers that practitioners face when initiating insulin therapy in general practice settings and how they can be overcome.
abstract: OBJECTIVE
  To explore primary care physicians' perspectives on possible barriers to the use of insulin.
  
  
  METHODS
  This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight electronic databases were searched (between January 1, 1994 and August 31, 2014) for relevant studies. A search for grey literature and a review of the references in the retrieved studies were also conducted. Studies that focused on healthcare providers' perspectives on possible barriers to insulin initiation with type 2 diabetic patients were included, as well as articles suggesting solutions for these barriers. Review articles and studies that only considered patients' perspectives were excluded.
  
  
  RESULTS
  A total of 19 studies met the inclusion criteria and were therefore included in this study: 10 of these studies used qualitative methods, 8 used quantitative methods and 1 used mixed methods. Studies included a range of different health care settings. The findings are reported under four broad categories: The perceptions of primary care physicians about the barriers to initiate insulin therapy for type 2 diabetes patients, how primary care physicians assess patients prior to initiating insulin, professional roles and possible solutions to overcome these barriers. The barriers described were many and covered doctor, patient, system and technological aspects. Interventions that focused on doctor training and support, or IT-based decision support were few, and did not result in significant improvement.
  
  
  CONCLUSIONS
  Primary care physicians' known delay in insulin initiation is multifactorial. Published reports of attempts to find solutions for these barriers were limited in number.
authors.affiliation: Abdulaziz Bin rsheed, Department of Family and Community Medicine, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia.
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Bin Rsheed
authors.affiliation: Abdulaziz Bin rsheed, Department of Family and Community Medicine, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia.
authors.forename: Ian
authors.initials: I
authors.lastname: Chenoweth
keywords: Barriers; Delay; Diabetes; Initiation; Insulin; Primary care physicians