Attitudes and beliefs of South African primary healthcare practitioners on initiating insulin in people with type 2 diabetes: Findings from the Tshwane Insulin Project (TIP)

Piotie, Patrick Ngassa; Wood, Paola; Muchiri, Jane Wanjiku; Webb, Elizabeth M.; Rheeder, Paul

doi:10.1016/j.pcd.2021.06.005

Cited by 4 publications

(7 citation statements)

References 36 publications

(56 reference statements)

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“…While developing the TIP intervention, researchers conducted baseline surveys with healthcare providers, including nurses who believed that they would be able to initiate insulin provided that they were adequately trained. 29 Nurse-led interventions have been successful particularly when nurses followed simplified algorithms and protocols and were able to prescribe. 38 , 39 A nurse-led model of care for insulin initiation for people with T2D was tested in general practice in Australia and showed good results.…”

Section: Discussionmentioning

confidence: 99%

“…The findings of the baseline surveys have been published elsewhere. 13,29 Phase II: designing the TIP intervention The TIP intervention was designed by a transdisciplinary team comprising researchers with expertise in diabetes and internal medicine, health systems and public health, nursing, family medicine, human nutrition and exercise science. After consulting with various stakeholders including local and national health authorities as well as people living with diabetes, the researchers designed the intervention following an approach best described as 'designing for dissemination'.…”

Section: Phase I: Planning the Tip Interventionmentioning

confidence: 99%

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Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings

Piotie

Wood

Webb

et al. 2021

Therapeutic Advances in Endocrinology

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Background: In South Africa, initiating insulin for people with type 2 diabetes and subsequent titration is a major challenge for the resource-constrained healthcare system. Inadequate support systems in primary care, including not being able to access blood glucose monitors and test strips for self-monitoring of blood glucose, results in patients with type 2 diabetes being referred to higher levels of care. In primary care, initiation of insulin may be delayed due to a shortage of healthcare workers. The delayed initiation of insulin is also exacerbated by the reported resistance of both healthcare providers and people with type 2 diabetes to start insulin. In South Africa, telehealth provides an opportunity to overcome these challenges and manage insulin therapy in primary care. Methods: We describe the development of a digital health intervention including the framework used, the theoretical approach and subsequent implementation strategies. Results: This intervention is an innovative, nurse-driven and app-enabled intervention called ‘the Tshwane Insulin Project intervention’. The Tshwane Insulin Project intervention was designed and evaluated using the framework recommended by the Medical Research Council for complex interventions. The Tshwane Insulin Project intervention was developed in four sequential phases: planning, design, implementation and evaluation. The Tshwane Insulin Project intervention followed the Integrated Chronic Disease Management framework to facilitate implementation and acceptability. The Tshwane Insulin Project comprises a facility-level intervention, where nurses evaluate patients and initiate insulin, an individual-level intervention where community healthcare workers visit patients at their homes to follow-up and provide educational information, while using telehealth to enable physician-directed insulin titration if needed, and a community-level intervention aimed at empowering community healthcare workers to support people living with diabetes and raise awareness of diabetes. Conclusion: The technological advancements in digital health and telemedicine present an opportunity to improve diabetes care in resource-limited countries. This work can inform those intending to develop and implement complex interventions in primary healthcare in developing countries.

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Section: Discussionmentioning

confidence: 99%

Section: Phase I: Planning the Tip Interventionmentioning

confidence: 99%

Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings

Piotie

Wood

Webb

et al. 2021

Therapeutic Advances in Endocrinology

Self Cite

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“…In addition, a lack of knowledge regarding insulin initiation and intensification is a significant factor. 11,12 Practitioners' barriers can include the lack of knowledge and experience with regard to the use of guidelines related to insulin therapy, language barriers and fear of hypoglycaemia. 11 Patients' barriers Background: Type 2 diabetes (T2DM) is a leading cause of mortality in South Africa and resistance to the use of insulin is common.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa

Mathose

Mash²

2023

S Afr Fam Pract

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Background: Type 2 diabetes (T2DM) is a leading cause of mortality in South Africa and resistance to the use of insulin is common. This study aimed to explore factors that influence the initiation of insulin in patients with T2DM in primary care facilities in Cape Town, South Africa.Methods: An exploratory descriptive qualitative study was conducted. Seventeen semi-structured interviews were held with patients eligible for insulin, on insulin and primary care providers. Participants were selected by maximum variation purposive sampling. Data were analysed using the framework method in Atlas-ti.Results: Factors related to the health system, service delivery, clinical care and patients. Systemic issues related to the required inputs of workforce, educational materials, and supplies. Service delivery issues related to workload, poor continuity and parallel coordination of care. Clinical issues related to adequate counselling. Patient factors included a lack of trust, concerns about injections, impact on lifestyle and disposal of needles.Conclusion: Although resource constraints are likely to remain, district and facility managers can improve supplies, educational materials, continuity and coordination. Counselling must be improved and may require innovative alternative approaches to support clinicians who face high number of patients. Alternative approaches using group education, telehealth and digital solutions should be considered.Contribution: This study identified key factors influencing insulin initiation in patients with T2DM in primary care. These can be addressed by those responsible for clinical governance, service delivery and in further research.

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“…Early diagnosis and intervention can improve morbidity and mortality. Despite improving globally, diabetes management in developing countries is lagging, predisposing people living with diabetes to increased morbidity and mortality [4].…”

Section: Introductionmentioning

confidence: 99%

Health Care Resource Utilization in Adults Living With Type 1 Diabetes Mellitus in the South African Public Health Sector: Protocol for a 1-Year Retrospective Analysis With a 5-, 10-, and 25-Year Projection

Bhana¹,

Naidoo²,

Pillay³

et al. 2023

JMIR Res Protoc

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Background Type 1 diabetes mellitus (T1DM) is less common than type 2 diabetes mellitus but is increasing in frequency in South Africa. It tends to affect younger individuals, and upon diagnosis, exogenous insulin is essential for survival. In South Africa, the health care system is divided into private and public health care systems. The private system is well resourced, whereas the public sector, which treats more than 80% of the population, has minimal resources. There are currently no studies in South Africa, and Africa at large, that have evaluated the immediate and long-term costs of managing people living with T1DM in the public sector. Objective The primary objective was to quantify the cost of health care resource utilization over a 12-month period in patients with controlled and uncontrolled T1DM in the public health care sector. In addition, we will project costs for 5, 10, and 25 years and determine if there are cost differences in managing subsets of patients who achieve glycemic control (hemoglobin A1c [HbA1c] <7%) and those who do not. Methods The study was performed in accordance with Good Epidemiological Practice. Ethical clearance and institutional permissions were acquired. Clinical data were collected from 2 tertiary hospitals in South Africa. Patients with T1DM, who provided written informed consent, and who satisfied the inclusion criteria were enrolled in the study. Data collection included demographic and clinical characteristics, acute and chronic complications, hospital admissions, and so on. We plan to perform a cost-effectiveness analysis to quantify the costs of health care utilization in the preceding 12 months. In addition, we will estimate projected costs over the next 10 years, assuming that study participants maintain their current HbA1c level. The cost-effectiveness analysis will be modeled using the IQVIA CORE Diabetes Model. The primary outcome measures are incremental quality-adjusted life years, incremental costs, incremental cost-effectiveness ratios, and incremental life years. Results Ethical clearance and institutional approval were obtained (reference number 200407). Enrollment began on February 9, 2021, and was completed on August 24, 2021, with 224 participants. A database lock was performed on October 29, 2021. The statistical analysis and clinical study report were completed in January 2022. Conclusions At present, there are no data assessing the short- and long-term costs of managing patients with T1DM in the South African public sector. It is hoped that the findings of this study will help policy makers optimally use limited resources to reduce morbidity and mortality in people living with T1DM. International Registered Report Identifier (IRRID) RR1-10.2196/44308

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Attitudes and beliefs of South African primary healthcare practitioners on initiating insulin in people with type 2 diabetes: Findings from the Tshwane Insulin Project (TIP)

Cited by 4 publications

References 36 publications

Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings

Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings

Factors influencing insulin initiation in primary care facilities in Cape Town, South Africa

Health Care Resource Utilization in Adults Living With Type 1 Diabetes Mellitus in the South African Public Health Sector: Protocol for a 1-Year Retrospective Analysis With a 5-, 10-, and 25-Year Projection

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