Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2014

Organisational and health professional factors impacting on insulin initiation: An exploratory qualitative study  (#113)

Jo-Anne Manski-Nankervis 1 , John Furler 1 , Irene Blackberry 1 , Doris Young 1
  1. General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Vic, Australia

Background: Insulin initiation in general practice for people with type 2 diabetes is generally not occurring in a timely manner (1-3) and the majority of patients are referred to specialist care (4). Understanding factors which impact on the ability of health professionals to work together to facilitate this activity is important.  Relational coordination theory identifies key concepts that underpin effective interprofessional work: communication which is problem solving, timely, accurate and frequent which is dependent on relationships between professional roles, characterized by shared goals, shared knowledge and mutual respect (5).

Aims: To explore the views of Victorian GPs, physicians, practice nurses and CDE-RNs about insulin initiation including roles, setting and coordination of care using relational coordination as a theoretical framework.

Method: Health professionals who completed a survey on this topic were recruited to participate in a semi-structured interview. Current professional roles and factors impacting on relational coordination in the context of initiation of insulin were explored. Framework analysis was used to analyse the interviews.

Results: 21 health professionals participated in the study. The five main themes identified in the interviews were: (1) Role definitions for specialists are agreed but roles in primary care, particularly in respect to practice nurses, are more contentious. (2) Lack of knowledge of practice nurse skills and roles are barriers to specialist support for their role in insulin initiation. (3) Relational coordination is  generally stronger within levels of care or where there is physical co-location. (4) Personal knowledge of health professionals and their work practices impacts on relationships. (5) There is a mismatch between some CDE-RN perceptions of the respect they receive from GPs and practice nurses and that expressed by these health professionals.

 Conclusion: Understanding and addressing the factors which are currently impacting on insulin initiation, including existing levels of relational coordination between health professionals, will be important when designing models of care for insulin initiation in general practice. 

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  3. Davis TME, Davis WA, Bruce DG. Glycaemic levels triggering intensification of therapy in type 2 diabetes in the community: the Fremantle Diabetes Study. Medical Journal of Australia. 2006;184:325-8.
  4. Britt H, Miller GC, Charles J, Henderson J, Bayram C, Valenti L, et al. General Practice Activity in Australia 2008-09. Canberra:AIHW; 2009.
  5. Gittell JH. Relational coordination: Guidelines for theory, measurement and analysis. Brandeis University, Waltham, MA 2011.