Dificultades en la prescripción racional de insulina: La percepción de los médicos tratantes de enfermos diabéticos de atención primaria de salud

Abstract

Background: Type 2 Diabetes Mellitus is not always treated successfully, in part due to the difficulties perceived by the medical community about the use of insulin. Aim: To identify the constraints perceived by primary care physicians (PCPs) in the prescription and use of insulin. Material and Methods: Six PCPs were subjected to a semi-structured interview about self-perceived management difficulties, behaviors and beliefs on the use of insulin among diabetics. According to their responses a questionnaire about the subject was devised and PCPs were invited by e-mail to answer it. Results: There were 88 replies and 48% of respondents recognized to have management deficiencies in at least one aspect of insulin prescription. The most common deficiencies were determining the type of insulin and treatment of complications. The perceived difficulties were lack of training (58.0%), lack of medical hours (46.6%), lack of communication with specialists (46.6%), lack of reactive strips for capillary blood glucose determination (43.2%) and rotation of doctors (40.9%). The most common behaviors towards patients reluctant to use insulin were persuasion (83.0%), education and supervision (63.6%) and signature of an ad-hoc document (38.6%). Ninety percent considered that timely use of insulin is more beneficial than its prescription as a last resort and 94.3% did not consider that insulin should be prescribed by a specialist. Conclusions: A significant percentage of physicians do not trust their own knowledge about insulin prescription. These professionals should receive training in not only technical aspects of prescribing insulin, but also in the psychological and persuasion strategies. There is willingness among PCPs to prescribe insulin.