What are the barriers faced by patients using insulin? A qualitative study of Malaysian health care professionals’ views

Abstract

BackgroundPatients with type 2 diabetes often require insulin as the disease progresses. However, health care professionals frequently encounter challenges when managing patients who require insulin therapy. Understanding how health care professionals perceive the barriers faced by patients on insulin will facilitate care and treatment strategies.ObjectiveThis study explores the views of Malaysian health care professionals on the barriers faced by patients using insulin.MethodsSemi-structured qualitative interviews and focus group discussions were conducted with health care professionals involved in diabetes care using insulin. Forty-one health care professionals participated in the study, consisting of primary care doctors (n = 20), family medicine specialists (n = 10), government policymakers (n = 5), diabetes educators (n = 3), endocrinologists (n = 2), and one pharmacist. We used a topic guide to facilitate the interviews, which were audio-recorded, transcribed verbatim, and analyzed using a thematic approach.ResultsFive themes were identified as barriers: side effects, patient education, negative perceptions, blood glucose monitoring, and patient adherence to treatment and follow-up. Patients perceive that insulin therapy causes numerous negative side effects. There is a lack of patient education on proper glucose monitoring and how to optimize insulin therapy. Cost of treatment and patient ignorance are highlighted when discussing patient self-monitoring of blood glucose. Finally, health care professionals identified a lack of a follow-up system, especially for patients who do not keep to regular appointments.ConclusionThis study identifies five substantial barriers to optimizing insulin therapy. Health care professionals who successfully identify and address these issues will empower patients to achieve effective self-management. System barriers require government agency in establishing insulin follow-up programs, multidisciplinary diabetes care teams, and subsidies for glucometers and test strips.

Primary care physician perspectives on barriers and facilitators to self-management of type 2 diabetes

“…Very few studies looking at the physician barriers in management of patients with T2DM have identified cost of treatment and healthy food choices as a barrier to intensifying treatment in order to achieve target A1c goals. [26] However, other barriers identified in this study, such as patient motivation, knowledge, adherence to diet and medications, physician's lack of time and lack of social support, echo the findings from previous studies. [10,15,[26][27][28][29][30] A study by Nam et al [15] identified physician factors such as their attitudes, beliefs and knowledge, and communication skills that can influence self-management in patients with T2DM.…”

Viewpoint: Using the patient-centred medicine clinical framework to better appreciate and explore the many barriers to care in Type 2 diabetes

“…This barrier was identified in 12 of the 28 articles. 12,13,16,20,21,[27][28][29][30]32,35,36 I. Disease and illness experience a) Fears/feelings as barriers to self-management i.…”

“…Fear or distress: The identified fear could be non-specific, such as fear of loss of control over their life, [14][15][16][17][18][19]37 or of potential future events (disease complications, 14,[22][23][24] and drug side effects 16,19,20,25,35,39 ). The fear could also be specific to events, such as glucose monitoring, 19,20,36 diagnosis, 18,21,22,24,29,37 starting oral medications, 16,18,19,36 starting insulin (including fear of insulin and needles), 16,[18][19][20][21]35,36,39 and fear of hypoglycaemia. 13,16,19 ii.…”

“…The process through which the patient and clinician reach mutual understanding and agreement in three key areas. specific beliefs, such as diabetes is caused by eating sugar, 15,19,23,36 a strict diet is required to control/cure diabetes, 18,19,36 only people with diabetes need to eat a healthy diet, 18,19,36,39 diabetes is like a 'cold' (it will just go away if ignored), 14,15,[17][18][19]23,27,29,35,36 diabetes is the same for everyone, 19,24 resignation to the diagnosis of diabetes, 15,23,24,29 symptoms as motivators (if there are no symptoms, then there is no need to take action), 15,18,19,21,23,29,32,33,35,36,39 diabetes is 'uncontrollable' (trouble coping), 15,20,31,34,39 they only need to take insulin if blood glucose is high, 35 and diabetes seen as a punishment. 15 ii.…”

“…i. Communication barriers: Besides poor communication in general, 12,13,17,19,22,27,34,36,39 use of jargon 19,22,24 and little knowledge transfer to the patient, 14,17,19,21,22,24,28,31,34,35 were specifically identified.…”