Physician related barriers towards insulin therapy at primary care centres in Trinidad: A cross-sectional study

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.