Leng Natasha Sheng Yeng, Chaterji Shera, Moosa Aminath Shiwaza, Chia Patricia Ching Yen, Lian Lay Geok, Li ZhengHua, Hooi Natalie Ming Foong, Lau Beth Shin Rei, Tan Ngiap Chuan
SingHealth Polyclinics, Singapore.
SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore.
J Prim Care Community Health. 2025 Jan-Dec;16:21501319251348973. doi: 10.1177/21501319251348973. Epub 2025 Jun 24.
Primary care physicians' (PCPs) prescription of oral anti-diabetic drugs (OADs) is pivotal to optimise glycaemic control of patients with type 2 diabetes mellitus (T2DM). Their decision-making process is not well-understood and is postulated to be multi-factorial. The study aimed to explore the factors influencing the prescribing behaviour of PCPs managing patients with T2DM in an urban setting.
A qualitative methodology using a descriptive-interpretive approach was employed for this study. Qualitative data from 23 PCPs was collected via 3 focus group discussions and 10 in-depth interviews using a semi-structured topic guide. PCPs with various experiences, qualifications and backgrounds were purposively recruited from public and private primary care clinics in Singapore. The audio-recorded interviews were transcribed verbatim and audited for accuracy. Thematic analysis was conducted and the emergent themes were grouped under the domains of the 'Generalist Wheel of Knowledge, Understanding and Inquiry' framework. The data was managed using Nvivo qualitative management software.
The 4 main themes identified were clinician experience and knowledge, patient clinical risk stratification and preference, diabetes severity and drug factors, and healthcare system. PCPs' prior experience with OADs, years of practice, academic roles and knowledge resources influenced their decision-making when prescribing OADs. Their prescription was guided by patient preferences and comorbidities, such as selecting sodium-glucose cotransporter-2 inhibitors for patients with proteinuria. Disease severity, OADs safety profile, efficacy, stipulations in the drug formulary, cost and availability of OADs in their pharmacy, and social worker support were other factors affecting PCPs' prescribing habits of OADs. Clinical decision support functionality in the electronic medical record (EMR) system prompted PCPs to select the type of OADs during the consultation.
The study highlights the multifaceted factors influencing PCPs' prescribing of OADs, including clinical experience, patient preferences, drug formulary limitations, medication costs and EMR utilisation. To enhance prescribing habits, interventions should focus on continuous education for PCPs, expanding drug formularies, addressing patients' preferences, cost and access barriers through subsidies and promoting the adoption of EMRs with clinical decision support systems in both public and private sectors.
基层医疗医生开具口服抗糖尿病药物（OADs）对于优化2型糖尿病（T2DM）患者的血糖控制至关重要。他们的决策过程尚未得到充分理解，据推测是多因素的。本研究旨在探讨影响城市环境中管理T2DM患者的基层医疗医生处方行为的因素。
本研究采用描述性解释方法的定性研究方法。通过3次焦点小组讨论和10次深入访谈，使用半结构化主题指南收集了23名基层医疗医生的定性数据。从新加坡的公立和私立基层医疗诊所中，有目的地招募了具有不同经验、资质和背景的基层医疗医生。对录音访谈进行逐字转录并审核准确性。进行了主题分析，并将新出现的主题归类在“通才知识、理解和探究轮”框架的领域下。使用Nvivo定性管理软件管理数据。
确定的4个主要主题是临床医生的经验和知识、患者临床风险分层和偏好、糖尿病严重程度和药物因素以及医疗保健系统。基层医疗医生以前使用OADs的经验、执业年限、学术角色和知识资源在开具OADs时会影响他们的决策。他们的处方受患者偏好和合并症的指导，例如为蛋白尿患者选择钠-葡萄糖协同转运蛋白-2抑制剂。疾病严重程度、OADs的安全性、疗效、药品处方集规定、成本以及药房中OADs的可获得性，以及社会工作者的支持是影响基层医疗医生OADs处方习惯的其他因素。电子病历（EMR）系统中的临床决策支持功能促使基层医疗医生在会诊期间选择OADs的类型。
该研究突出了影响基层医疗医生开具OADs的多方面因素，包括临床经验、患者偏好、药品处方集限制、药物成本和EMR的使用。为了改善处方习惯，干预措施应侧重于为基层医疗医生提供持续教育、扩大药品处方集、通过补贴解决患者偏好、成本和获取障碍，以及在公共和私营部门推广采用具有临床决策支持系统的EMR。
