Published online Jan 15, 2017. doi: 10.4239/wjd.v8.i1.28
Peer-review started: June 6, 2016
First decision: July 5, 2016
Revised: July 29, 2016
Accepted: October 17, 2016
Article in press: October 18, 2016
Published online: January 15, 2017
To explore primary care physicians’ perspectives on possible barriers to the use of insulin.
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight electronic databases were searched (between January 1, 1994 and August 31, 2014) for relevant studies. A search for grey literature and a review of the references in the retrieved studies were also conducted. Studies that focused on healthcare providers’ perspectives on possible barriers to insulin initiation with type 2 diabetic patients were included, as well as articles suggesting solutions for these barriers. Review articles and studies that only considered patients’ perspectives were excluded.
A total of 19 studies met the inclusion criteria and were therefore included in this study: 10 of these studies used qualitative methods, 8 used quantitative methods and 1 used mixed methods. Studies included a range of different health care settings. The findings are reported under four broad categories: The perceptions of primary care physicians about the barriers to initiate insulin therapy for type 2 diabetes patients, how primary care physicians assess patients prior to initiating insulin, professional roles and possible solutions to overcome these barriers. The barriers described were many and covered doctor, patient, system and technological aspects. Interventions that focused on doctor training and support, or IT-based decision support were few, and did not result in significant improvement.
Primary care physicians’ known delay in insulin initiation is multifactorial. Published reports of attempts to find solutions for these barriers were limited in number.
Core tip: There are several barriers to primary care physicians in initiating insulin therapy when it is required for type 2 diabetes patients. The main purpose of this systematic review is to explore these barriers in depth. Published reports of attempts to find solutions to these barriers were limited in number. Given the increasing burden of this chronic disease, and the need to optimize and standardize management, it is expected research in this area will remain intense. The research that remains patient-centered and takes a system approach can be expected to yield best results.