Physician related barriers towards insulin therapy at primary care centres in Trinidad: a cross-sectional study
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RESEARCH ARTICLE
Open Access
Physician related barriers towards insulin therapy at primary care centres in Trinidad: a cross-sectional study Shastri Motilal
Abstract Background: Physician related factors with respect to insulin therapy can contribute to diabetes mellitus (DM) mismanagement. Patient related factors have been previously explored in a Trinidad survey. The main objective of this study was to explore primary care physicians’ (PCPs) related barriers towards insulin therapy. Methods: A cross-sectional study on a convenience sample of PCPs in the public primary care system was done using an online survey. Results: Of the 170 PCPs contacted, 75 (44%) responded. There were 47 females (62.7%) and 28 males (37.3%) with a mean age of 35.9 yrs. Nearly 40% of physicians admitted that the education given to patients was inadequate to allow initiation of insulin therapy. Half the respondents admitted to insufficient consultation times and inadequate appointment frequency to allow for intensification of insulin therapy. Forty percent of PCPs admitted that HbA1c results were unavailable to guide their management decisions. Only 6.7% of physicians said they had access to rapid acting insulin, while 5.3% said they had access to insulin pens. Conclusion: PCPs in Trinidad treating diabetes at the public primary care clinics face several barriers in administering proper insulin therapy. Addressing these factors can improve glycemic control in this population. Keywords: Insulin, Insulin barriers, Type 2 diabetes mellitus, Primary care
Background Trinidad and Tobago are a twin island state in the Southern Caribbean with Trinidad accounting for 95% of the population. Occupying just over 5128 km2, Trinidad and Tobago has a high prevalence of diabetes mellitus (DM) with 12.3% of the adult population affected according to the International Diabetes Federation [1]. In 2016 DM accounted for 14% of all deaths and its economic burden in the region have been well documented [2, 3]. Poorly controlled DM is a major contributor to morbidity and mortality. The Caribbean Health Research Council Correspondence: [email protected] Department of Paraclinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine Campus, Eric Williams Medical Sciences Complex, Champs Fleurs, Trinidad
(CHRC) guidelines, endorsed by the Caribbean College of Family Physicians, supports an HbA1c of less than 6.5% as the target for glycemic control [4]. Previous Trinidadian studies have shown 40–55% of DM patients had an HbA1c above this recommended target [5, 6]. Diabetes is a progressive disease that is initially managed with lifestyle change, metformin and other oral hypoglycemic therapies. Insulin treatment is the major definitive effective treatment for those who remain uncontrolled on oral treatments [7]. Insulin has been available free of charge to Trinidad citizens since 2003 under the CDAP (chronic disease assistance programme) with satisfaction in the majority of CDAP drug users [8]. While the reasons for uncontroll
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