3878 : AN INTERNATIONAL STUDY OF PHYSICIAN RESISTANCE TO PRESCRIBE INSULIN

Author(s): 
Lauritzen, Torsten; Peyrot, Mark; Matthews, David; Rubin, Richard; Kleinebreil. Line; Colagiuri, Ruth; Ishii, Hitoshi; Snoek, Frank; Geelhoed, PH.L.; Skovlund, Soren
Text: 
Oral Presentation
Research Based
BACKGROUND AND AIMS: This study examined resistance to prescribing insulin. MATERIALS AND METHODS: We surveyed 2, 681 family physicians and internists treating type 2 diabetes, approximately 500 in each of 13 countries. This is a subanalysis of the international study of Diabetes Attitudes, Wishes and Needs (DAWN). Reported findings are pRESULTS: Physicians differed by country in attitudes about prescribing insulin. 42% were reluctant to start insulin treatment until absolutely essential; further 16% were undecided/ambivalent. Physicians less resistant to prescribing insulin were younger, more likely to be internists, and located in multidisciplinary settings. Years of treating patients and number of patients were not related to resistance. Those who speak to and write for audiences of lay persons and providers were less resistant to prescribing insulin. Physicians who were more resistant saw their patients as more compliant with medication. The two strongest predictors of resistance to prescribing insulin were general reluctance to use medications to control blood glucose (associated with higher resistance) and belief that earlier use of insulin would reduce the cost of diabetes care (associated with lower resistance).
CONCLUSIONS: Physicians report substantial resistance to prescribing insulin. This resistance may be an important element in the delay of insulin use when it would be helpful, and may keep patients from being able to manage their diabetes effectively. Understanding the determinants of this resistance may facilitate efforts to increase physician willingness to prescribe insulin as a means of improving diabetes management.
Topic: Clinical Practice