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Table 3 Main themes and subthemes in relation to future program development

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

Aspects related to program satisfaction
Patient views ‘It is easier to start in primary care. Our GP lives across the street. He’s known us for years.’ (interview patients; P2) ‘The DNE has the time to give us information. She explained everything to me; why I have to use insulin, how I should use it, … it is really nice.’ (interview patients; P 3) “They” (DNE, GP) work together very well. On one occasion my results were not good. The DNE phoned my GP and they agreed on changing my therapy.’ (interview patients; P 9)
- GP is in charge
- information
- emotional support
- time
- flexibility
- free of charge
- collaboration between DNE and GP
GP views ‘The workshop was very good. The information was to the point, very clear.’ (focus group; GP 2) ‘For most patients insulin therapy is still the last thing they want to start with. They have no problems with an extra tablet, but starting insulin therapy is still an enormous threshold to overcome. Although, once they are on insulin most of them have no problem with it.’ (focus group; GP 9) ‘The DNE has the competence and the time to give information to the patient. When we engage ourselves in insulin therapy, we have to do it well. With the support of the DNE I feel comfortable.’ (focus group GP 8)
- information in workshops
- protocol
- support in primary care
- overcoming patients’ barriers
- patients are satisfied
- structured approach by DNE
- communication with DNE
- coaching by the specialist
Aspects for consideration in future program development
Job boundaries between DNE and GPs ‘We were not used to this kind of service in primary care. We need time to learn how we can work together.’ (focus group; GP 3) ‘I see my patient every three months. In between the DNE is responsible for adjusting insulin doses. She communicates with the patient regarding this topic. I feel relieved that I can delegate this job to her.’ (focus group; GP 4)
- new function in primary care
- fear to lose the patient
- control over therapy
- limited tradition of collaboration
Job boundaries between GPs and specialists ‘Patients in the program receive the advice to consult the specialist once they require two or more injections a day. This has prevented me from referring patients to the support program.’(one-to-one interview; GP 3)
- limitation to once daily insulin regimen
- engagement of specialists
Protocol adherence ‘When insulin therapy is initiated, patients always do more measurements. There is ’the fear of hypoglycaemia’. I suppose this is normal.’ (focus group, GP 8) ‘I like to have a glycaemic value during the day. It reassures me.‘ (focus group; GP 1)
- postponement of dose titration
- fear of hypoglycaemia
- treating the regimen as a complex one
- limited engagement of patients in dose adjustment