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首页> 外文期刊>BMC Family Practice >Perceptions of insulin use in type 2 diabetes in primary care: a thematic synthesis
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Perceptions of insulin use in type 2 diabetes in primary care: a thematic synthesis

机译：初级保健中2型糖尿病患者的胰岛素使用的看法：主题合成

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Increasing numbers of patients with type 2 diabetes mellitus are progressing to insulin therapy, and despite its potency many such individuals still have suboptimal glycaemic control. Insulin initiation and intensification is now often conducted by Practice Nurses and General Practitioners in many parts of the UK. Therefore, gaining insight into perspectives of patients and primary care clinicians is important in determining self-management and engagement with insulin. A thematic synthesis of studies was conducted exploring the views and experiences of people with type 2 diabetes and of healthcare professionals on insulin use and management in the context of primary care. Protocol based systematic searches of electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Web of Science) were performed on 1 October 2014 and updated on 31 March 2015, to identify studies that identified the views and experiences of adults with type 2 diabetes or primary care clinicians on the use of insulin in the management of type 2 diabetes. Studies meeting the review inclusion criteria were critically appraised using the CASP qualitative research checklist or Barley’s checklist for survey designs. A thematic synthesis was then conducted of the collected studies. Thirty-four studies were selected. Of these, 12 used qualitative interviews (nine with patients and three with healthcare professionals) and 22 were survey based (14 with patients, three with healthcare professionals, and five with both). Twelve key themes were identified and formed three domains, patient perceptions, healthcare professional perceptions, and health professional-patient relationships. The patient-centred themes were: insulin-related beliefs, social influences, psychological factors, hypoglycaemia, and therapy barriers. The clinician-related themes were: insulin skills of general practitioners, healthcare integration, healthcare professional-perceived barriers, hypoglycaemia, and explanations for adherence. Healthcare professional-patient relationship themes were drawn from the perspectives of patients and from clinicians. This review reveals multiple barriers to optimal insulin use in primary care at both the patient and healthcare professional levels. These barriers indicate the need for multimodal interventions to: improve the knowledge and competencies of primary care professionals in insulin use; provide more effective patient education and self-management support; and introduce integrated insulin support systems.
机译：患有2型糖尿病患者的患者患者正在进行胰岛素治疗，尽管其效力许多这样的个体仍有次甙控制。胰岛素启动和强化现在经常通过英国许多地方的实践护士和普通从业者进行。因此，对患者和初级保健临床医生的洞察力的洞察力在确定与胰岛素的自我管理和接触方面很重要。对研究的主题综合进行了探索2型糖尿病和医疗保健专业人员的观点和经验，并在初级保健背景下对胰岛素使用和管理进行管理。基于协议的系统搜索电子数据库（CINAHL，Cochrane图书馆，EMBASE，MEDLINE，PSYCINFO和科学版）于2014年10月1日在2015年10月1日进行，并于2015年3月31日更新，以确定确定成年人的观点和经验的研究2糖尿病或初级保健临床医生在2型糖尿病中使用胰岛素。符合审查包容标准的研究通过Casp定性研究清单或大麦清单进行调查设计批判性评估。然后对收集的研究进行了主题合成。选择了三十四项研究。其中，12次使用的定性访谈（与医疗专业人士的九人和三个）和22名是基于调查（14名患者，三个带有医疗保健专业人士，以及两种）。确定并形成了十二个关键主题，并形成了三个域，患者感知，医疗保健专业知情和健康专业患者关系。患者为中心的主题是：胰岛素相关的信念，社会影响，心理因素，低血症和治疗障碍。临床医生有关的主题是：一般从业者，医疗保健融合，医疗保健专业人知的障碍，低血糖和遵守的解释的胰岛素技能。从患者和临床医生的角度来看，医疗保健专业患者关系主题。本综述显示患者和医疗保健专业水平的初级保健中最佳胰岛素使用的多种障碍。这些障碍表示需要多式联算干预：提高胰岛素使用中初级保健专业人员的知识和能力;提供更有效的患者教育和自我管理支持;并引入综合胰岛素支持系统。

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