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

机译：使用胰岛素的患者面临哪些障碍？对马来西亚医疗保健专业人员意见的定性研究

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Background: Patients 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.Objective: This study explores the views of Malaysian health care professionals on the barriers faced by patients using insulin.Methods: Semi-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.Results: Five 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.Conclusion: This 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.
机译：背景：随着疾病的进展，2型糖尿病患者通常需要胰岛素。但是，医疗保健专业人员在管理需要胰岛素治疗的患者时经常遇到挑战。了解医疗保健专业人员如何理解患者在胰岛素方面面临的障碍将有助于护理和治疗策略。目的：本研究探讨马来西亚医疗保健专业人员对使用胰岛素患者面临的障碍的观点。方法：半结构化定性访谈和重点关注与参与胰岛素治疗的医护人员进行了小组讨论。共有41位医疗保健专业人员参加了研究，其中包括初级保健医生（n = 20），家庭医学专家（n = 10），政府决策者（n = 5），糖尿病教育者（n = 3），内分泌专家（n = 2）和一名药剂师。我们使用了一个主题指南来促进访谈，这些访谈经过录音，逐字记录并使用主题方法进行了分析。结果：确定了五个主题作为障碍：副作用，患者教育，负面认识，血糖监测和患者坚持治疗和随访。患者认为胰岛素治疗会引起许多负面影响。缺乏对患者进行适当的葡萄糖监测以及如何优化胰岛素治疗的教育。在讨论患者对血糖的自我监测时，强调了治疗费用和患者的无知。最后，医疗保健专业人员发现缺乏随访系统，尤其是对于那些不定期就诊的患者。结论：本研究确定了优化胰岛素治疗的五个主要障碍。成功识别并解决这些问题的医疗保健专业人员将使患者能够实现有效的自我管理。系统壁垒要求政府机构建立胰岛素跟进计划，多学科糖尿病护理团队以及对血糖仪和试纸的补贴。

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