Insulin therapy in type 2 diabetes is no longer a secondary care activity in the Netherlands

Avendonk, M. J. P. van; Gorter, Kees J.; Donk, Maureen van den; Rutten, Guy E.H.M.

doi:10.1016/j.pcd.2008.10.007

Cited by 22 publications

(22 citation statements)

References 18 publications

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“…In particular, specialists generally reported that DNE involvement was still required. However, whilst some general practices have timely access to a DNE, not all do and this is the reason that an enhanced role for the PN is being proposed, in line with that occurring in other countries [19,39]. GPs working in partnership with a PN to initiate insulin for people with uncomplicated T2D, with access to specialist input if required, could help to address the issue of delays in treatment intensification and people with sub-optimal glycaemia.…”

Section: Discussionmentioning

confidence: 99%

“…However, when insulin initiation is required it is generally not occurring in a timely manner [11-13] and it has been shown that primary care physicians are more likely to delay initiating insulin compared to specialist colleagues [14]. Despite evidence that it is safe to initiate insulin in general practice [15-17] and it being a core general practice activity in countries such as the United Kingdom [18] and the Netherlands [19], in Australia the majority of patients are referred to specialist care for insulin initiation [20]. However, the relative scarcity of these health professionals [21-23] can result in delays to starting this treatment.…”

Section: Introductionmentioning

confidence: 99%

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Roles and relationships between health professionals involved in insulin initiation for people with type 2 diabetes in the general practice setting: a qualitative study drawing on relational coordination theory

et al. 2014

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BackgroundThe majority of care for people with type 2 diabetes occurs in general practice, however when insulin initiation is required it often does not occur in this setting or in a timely manner and this may have implications for the development of complications. Increased insulin initiation in general practice is an important goal given the increasing prevalence of type 2 diabetes and a relative shortage of specialists. Coordination between primary and secondary care, and between medical and nursing personnel, may be important in achieving this. Relational coordination theory identifies key concepts that underpin effective interprofessional work: communication which is problem solving, timely, accurate and frequent and relationships between professional roles which are characterized by shared goals, shared knowledge and mutual respect. This study explores roles and relationships between health professionals involved in insulin initiation in order to gain an understanding of factors which may impact on this task being carried out in the general practice setting.Method21 general practitioners, practice nurses, diabetes nurse educators and physicians were purposively sampled to participate in a semi-structured interview. Transcripts of the interviews were analysed using framework analysis.ResultsThere were four closely interlinked themes identified which impacted on how health professionals worked together to initiate people with type 2 diabetes on insulin: 1. Ambiguous roles; 2. Uncertain competency and capacity; 3. Varying relationships and communication; and 4. Developing trust and respect.ConclusionsThis study has shown that insulin initiation is generally recognised as acceptable in general practice. The role of the DNE and practice nurse in this space and improved communication and relationships between health professionals across organisations and levels of care are factors which need to be addressed to support this clinical work. Relational coordination provides a useful framework for exploring these issues.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Roles and relationships between health professionals involved in insulin initiation for people with type 2 diabetes in the general practice setting: a qualitative study drawing on relational coordination theory

et al. 2014

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“…In general, disease management refers to a patient-centered approach that aims to improve, structure and coordinate delivery of health care services to a specific patient group [7]. In 2013, more than 80% percent of diabetes care in the Netherlands was delivered in primary care settings [8], including former secondary care such as delivering insulin therapy [9]. In practice, general practitioners delegated most of diabetes care activities to practice nurses or specially trained diabetes nurses [10].…”

Section: Introductionmentioning

confidence: 99%

The development of integrated diabetes care in the Netherlands: a multiplayer self-assessment analysis

Zonneveld

Vat

Vlek

et al. 2017

BMC Health Serv Res

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BackgroundSince recent years Dutch diabetes care has increasingly focused on improving the quality of care by introducing the concept of care groups (in Dutch: ‘zorggroepen’), care pathways and improving cooperation with involved care professionals and patients. This study examined how participating actors in care groups assess the development of their diabetes services and the differences and similarities between different stakeholder groups.MethodsA self-evaluation study was performed within 36 diabetes care groups in the Netherlands. A web-based self-assessment instrument, based on the Development Model for Integrated Care (DMIC), was used to collect data among stakeholders of each care group. The DMIC defines nine clusters of integrated care and four phases of development. Statistical analysis was used to analyze the data.ResultsRespondents indicated that the diabetes care groups work together in well-organized multidisciplinary teams and there is clarity about one another’s expertise, roles and tasks. The care groups can still develop on elements related to the management and monitoring of performance, quality of care and patient-centeredness. The results show differences (p < 0.01) between three stakeholders groups in how they assess their integrated care services; (1) core players, (2) managers/directors/coordinators and (3) players at a distance. Managers, directors and coordinators assessed more implemented integrated care activities than the other two stakeholder groups. This stakeholder group also placed their care groups in a further phase of development. Players at a distance assessed significantly less present elements and assessed their care group as less developed.ConclusionsThe results show a significant difference between stakeholder groups in the assessment of diabetes care practices. This reflects that the professional disciplines and the roles of stakeholders influence the way they asses the development of their integrated care setting, or that certain stakeholder groups could be less involved or informed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2167-6) contains supplementary material, which is available to authorized users.

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“…Although there have been studies of physicians’ attitudes toward recommending lifestyle changes after a diagnosis of T2DM [12, 13], or their attitudes toward treatment intensification with insulin [14–17], there are limited data evaluating the reasons given by primary care physicians for not initiating antihyperglycemic therapy in older patients with T2DM. Therefore, the objectives of the present study were, first, to describe the clinical characteristics of patients aged ≥65 years who had not been treated with oral antihyperglycemic therapy in the 6 or more months following diagnosis of T2DM, and second, to report the reasons given by primary care physicians for not initiating oral antihyperglycemic therapy in their patients.…”

Section: Introductionmentioning

confidence: 99%

Physician Reasons for Nonpharmacologic Treatment of Hyperglycemia in Older Patients Newly Diagnosed with Type 2 Diabetes Mellitus

et al. 2012

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IntroductionTo identify reasons why primary care physicians (PCPs) do not treat older patients newly diagnosed with type 2 diabetes mellitus (T2DM) with antihyperglycemic agents following diagnosis.MethodsUS PCPs were surveyed via the internet regarding their reasons for not treating patients aged >65 years diagnosed with T2DM and had not yet initiated antihyperglycemic therapy for ≥6 months after diagnosis. PCPs were requested to provide relevant clinical information for untreated older patients and select applicable reasons for not initiating treatment from a list of 35 possibilities, grouped into five categories.ResultsA total of 508 PCPs completed the online survey and provided complete clinical data for 770 patients. The reasons provided by the first-ranked physician for not initiating antihyperglycemic therapy were related to diet and exercise (57.5%); mild hyperglycemia (23.8%); patient’s concerns (13.4%); concerns about antihyperglycemic agents (3.0%); and comorbidities and polypharmacy (2.3%). The “diet and exercise” category was the most common first-ranked non-treatment reason, regardless of recent hemoglobin A1c (HbA1c) stratum. Reasons within the “patient’s concerns,” “concerns related to antihyperglycemic agents,” and “comorbidities and polypharmacy” categories tended to be selected more often as first-ranked reasons by physicians for patients with higher HbA1c values. Of the 158 patients whose physicians planned to initiate antihyperglycemic therapy within the next month, 54.4% already had a most recent HbA1c value above their physician-stated threshold for treatment initiation.ConclusionIn the PCPs studied, there was a tendency to select appropriate reasons for non-treatment with antihyperglycemic agents given their patients’ glycemic status. However, there was inertia related to the initiation of pharmacological therapy in some older patients with newly diagnosed T2DM. Important factors included physicians’ perceptions of “mild” hyperglycemia and the HbA1c threshold for using antihyperglycemic agents.

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Insulin therapy in type 2 diabetes is no longer a secondary care activity in the Netherlands

Cited by 22 publications

References 18 publications

Roles and relationships between health professionals involved in insulin initiation for people with type 2 diabetes in the general practice setting: a qualitative study drawing on relational coordination theory

Roles and relationships between health professionals involved in insulin initiation for people with type 2 diabetes in the general practice setting: a qualitative study drawing on relational coordination theory

The development of integrated diabetes care in the Netherlands: a multiplayer self-assessment analysis

Physician Reasons for Nonpharmacologic Treatment of Hyperglycemia in Older Patients Newly Diagnosed with Type 2 Diabetes Mellitus

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