Peyrot Mark, Rubin Richard R
Department of Sociology, Loyola College, Baltimore, MD 21210-2699, USA.
Curr Med Res Opin. 2008 Aug;24(8):2413-22. doi: 10.1185/03007990802278644. Epub 2008 Jul 14.
To determine the way in which physicians perceive insulin pens and the factors that affect their recommendations and their patients' pen initiation/use.
Primary care physicians ( N = 300; 108 family practice, 192 internal medicine) and endocrinologists (N = 225) were recruited from national databases (IMS and AMA) to participate in an Internet survey. All data are self-reports. Measures include five dependent variables (the extent of suitability for patient segments, two pen-related behaviors--their frequency of presenting patients with the pen as a treatment option and strength of pen recommendation--and extent of their patients' pen initiation and use) and several potential correlates: practice characteristics; therapeutic philosophy and practices; perceptions of insulin pens (convenience, facilitation of self-care, blood glucose control efficacy, cost/coverage). Correlates of dependent variables were examined using multiple linear regression.
Significantly (p < 0.05) more patient pen use and/or successful pen initiation was reported by physicians who: (1) were more involved in clinical practice, were early adopters of clinical innovations or instructed their patients regarding insulin use; (2) reported less insulin mixing or therapeutic inertia; (3) perceived pens as efficacious and facilitating self-care; and (4) presented and recommended pens to their patients. More frequent presentation of pens to patients and/or stronger recommendation of pen use was reported by physicians who were early innovation adopters, reported less insulin mixing or therapeutic inertia, and perceived pens as convenient and efficacious (p < 0.05).
The study is a cross-sectional survey using a self-administered questionnaire yielding unverified self-reports. Physicians treating few patients with diabetes mellitus or prescribing no insulin were excluded from the study.
Physicians' pen-related actions are a function of their personal and practice characteristics as well as their perceptions of pens. Physicians' presentation of pens as an option is strongly associated with perceived pen convenience, but physicians' pen recommendations and the estimated pen use/initiation of their patients are most strongly associated with the perception of clinically relevant pen attributes--glucose control efficacy and/or self-care facilitation.
确定医生对胰岛素笔的认知方式以及影响他们推荐胰岛素笔和患者开始使用/使用胰岛素笔的因素。
从国家数据库（IMS和美国医学协会）招募基层医疗医生（N = 300；108名家庭医生，192名内科医生）和内分泌科医生（N = 225）参与一项网络调查。所有数据均为自我报告。测量指标包括五个因变量（对患者群体的适用程度、两种与笔相关的行为——向患者推荐笔作为治疗选择的频率和推荐笔的力度——以及患者开始使用和使用胰岛素笔的程度）和几个潜在的相关因素：执业特征；治疗理念和实践；对胰岛素笔的认知（便利性、促进自我护理、血糖控制效果、成本/保险范围）。使用多元线性回归分析因变量的相关因素。
以下医生报告的患者使用胰岛素笔和/或成功开始使用胰岛素笔的情况显著更多（p < 0.05）：（1）更多参与临床实践、是临床创新的早期采用者或指导患者使用胰岛素的医生；（2）报告胰岛素混合或治疗惰性较少的医生；（3）认为胰岛素笔有效且便于自我护理的医生；（4）向患者展示并推荐胰岛素笔的医生。早期采用创新、报告胰岛素混合或治疗惰性较少且认为胰岛素笔方便有效的医生报告向患者更频繁地展示胰岛素笔和/或更强力地推荐使用胰岛素笔（p < 0.05）。
该研究是一项横断面调查，使用自我填写的问卷，得到的是未经核实的自我报告。治疗糖尿病患者较少或未开具胰岛素处方的医生被排除在研究之外。
医生与胰岛素笔相关的行为是其个人和执业特征以及对胰岛素笔认知的函数。医生将胰岛素笔作为一种选择展示与感知到的笔的便利性密切相关，但医生对胰岛素笔的推荐以及其患者预计的笔的使用/开始使用情况与对临床相关笔的属性——血糖控制效果和/或自我护理便利性的认知最密切相关。
