advancing insulin prescribing in general practice

Conditions: Diabetes Mellitus

Summary: family physicians, the subjects of this trial are reluctant to initiate insulin in patients with type 2 diabetes due to a lack of familiarity and comfort with this clinical strategy. this study will test the effectiveness of diabetes specialist consultation support, and community pharmacy insulin initiation support on the insulin prescribing behaviour of family physicians across canada.

the 2003 canadian diabetes association clinical practice guidelines recommend early and sustained glycemic control targeting an glycosylated hemoglobin (a1c) \< 7%. the guideline target however is not achieved in 50% of patients with type 2 diabetes in the canadian family practice setting. family physicians are not comfortable initiating and managing insulin for their patients the diabetes in canada evaluation (dice) study found that only 12% of the 2473 patients audited were prescribed insulin; 6% insulin alone and 6% in combination. harris et. al. found 20% of patients prescribed insulin, 15% insulin alone and 5% in combination. a strategy to increase physicians' knowledge, skill and comfort with insulin prescription is needed to better achieve glycemic control for patients with type 2 diabetes in canada. purpose - the purpose of aim@gp is to increase family physicians clinical experience and comfort with insulin prescription and better achieve glycemic control for patients with type 2 diabetes in canada. primary objective - to determine the effectiveness of a basal insulin initiation strategy on family physician insulin prescribing behaviour. the strategy, using a multifaceted behaviour facilitation approach, includes diabetes specialist consultation support, and community pharmacy insulin initiation support. study design - the study design is a stratified, parallel group, randomized control effectiveness study. all physicians will attend an insulin education workshop where they will receive a diabetes practice profile and randomly allocated in a 1:1 manner into the intervention or control group.

Eligibility criteria:
inclusion criteria: * full time family physicians (fp) \>25 hours per week in office * ability to generate a listing of patients with type 2 diabetes (t2dm) from their practice or billing records. * generation of a practice list of patients with t2dm * a minimum of 50 patients with type 2 diabetes in their practice. * support the generation of a diabetes practice profile prior to the deadline established * a minimum of 6 insulin-eligible patients * attendance at the scheduled workshop (if unable to attend the workshop must be available to be educated and trained by diabetes nurse educator(dne) using a workshop dvd) exclusion criteria: * fp does not attend workshop or complete educational training using workshop dvd with dne guidance * fps who anticipate retiring within the post-intervention period, moving their practice to another city, or having locum coverage of their practice for more than 4 weeks during the post-intervention period * fps currently participating in a diabetes behaviour-change intervention trial * fps working in an academic environment * fps unlikely to comply with protocol, (uncooperative attitude, unlikelihood of completing the study).

Keywords: insulin diabetes mellitus practice behaviour preceptor pharmacy