Engaging GPs in insulin therapy initiation: a qualitative study evaluating a support program in the Belgian context

Area of Science:

• Diabetes care quality improvement
• Primary care research
• Health services research

Background:

• A Belgian quality improvement project introduced a program to support insulin therapy initiation in primary care.
• This study investigates factors influencing general practitioners' (GPs) engagement in this program.
• The research also explores elements for enhancing future program development.

Purpose of the Study:

• To identify factors influencing general practitioners' (GPs) engagement in insulin therapy initiation.
• To gather insights for optimizing the design and implementation of future diabetes care support programs.

Main Methods:

• Semi-structured interviews with GPs (focus groups and one-to-one) were conducted.
• Data were triangulated with patient interviews, diabetes nurse educator (DNE) and specialist interviews, and program evaluation reports.
• Qualitative data analysis explored engagement barriers and facilitators.

Main Results:

• Differences in attitude, subjective norm, and perceived behavioral control were observed between engaged and non-engaged GPs.
• The support program received positive evaluations from users.
• Key areas for improvement include clarifying job boundaries (DNE/GP, GP/specialist), enhancing protocol adherence, and addressing caseload limitations.

Conclusions:

• Transitioning insulin initiation to primary care presents challenges, with many GPs hesitant despite available support.
• Future program development should focus on interdisciplinary approaches for job clarification.
• A dynamic integration of expertise and feedback on protocol adherence are crucial for successful primary care-based insulin initiation.