Haque M, Emerson S H, Dennison C R, Navsa M, Levitt N S
Primary Health Care, Department of Public Health, University of Cape Town Cape Town, South Africa.
S Afr Med J. 2005 Oct;95(10):798-802.
The majority of patients with type 2 diabetes mellitus in Cape Town who attend primary care community health centres (CHCs) have unsatisfactory glycaemic control. Insulin is rarely prescribed despite its being indicated for type 2 diabetic patients with inadequate metabolic control on maximum oral glucose-lowering agent (OGLA) therapy.
The study examined barriers to initiating insulin therapy in poorly controlled type 2 diabetes patients on maximum OGLAs in CHCs in the Cape Town metropolis.
Five focus group discussions and 10 in-depth semistructured individual interviews were conducted with 46 medical officers working at the CHCs. The discussions and interviews were transcribed and common themes were identified and categorised.
Doctor, patient, and system barriers to initiating insulin therapy were identified. Doctors' barriers include lack of knowledge, lack of experience with and use of guidelines related to insulin therapy, language barriers between doctor and patients, and fear of hypoglycaemia. Patient barriers were mistaken beliefs about insulin, non-compliance, lack of understanding of diabetes, use of traditional herbs, fear of injections, and poor socioeconomic conditions. System barriers were inadequate time, lack of continuity of care and financial constraints.
Suggestions for overcoming barriers include further education of doctors on insulin initiation and the use of standardised guidelines. In addition, a patient-centred approach with better communication between doctors and patients, which may be achieved by reorganising aspects of the health system, may improve patient knowledge, address mistaken beliefs, improve compliance and help overcome barriers. Further research is needed to investigate these recommendations and assess patients' and nurses' perceptions on initiating insulin therapy.
在开普敦，前往初级保健社区健康中心（CHC）就诊的大多数2型糖尿病患者血糖控制不佳。尽管胰岛素适用于接受最大剂量口服降糖药（OGLA）治疗但代谢控制仍不理想的2型糖尿病患者，但胰岛素很少被处方使用。
本研究调查了在开普敦大都市的社区健康中心，接受最大剂量OGLA治疗的血糖控制不佳的2型糖尿病患者启动胰岛素治疗的障碍。
对在社区健康中心工作的46名医务人员进行了5次焦点小组讨论和10次深入的半结构化个人访谈。对讨论和访谈内容进行了转录，并确定了共同主题并进行了分类。
确定了启动胰岛素治疗的医生、患者和系统障碍。医生的障碍包括知识不足、缺乏胰岛素治疗相关指南的经验和使用、医患之间的语言障碍以及对低血糖的恐惧。患者的障碍包括对胰岛素的错误认知、不依从、对糖尿病缺乏了解、使用传统草药、害怕打针以及社会经济状况不佳。系统障碍包括时间不足、缺乏连续护理和经济限制。
克服障碍的建议包括对医生进行关于胰岛素起始治疗和使用标准化指南的进一步教育。此外，通过重组卫生系统的某些方面来实现以患者为中心的方法，加强医患之间的沟通，可能会提高患者知识水平、消除错误认知、提高依从性并有助于克服障碍。需要进一步研究来调查这些建议，并评估患者和护士对启动胰岛素治疗的看法。
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