B.K. MATHEW1, J.G. DE ROZA1, E. CHEN2, W.E.TANG2, C. LIU1, L.J. GOH1, E. P. SHIXUAN1
NHG Polyclinics1, National Healthcare Group HQ2
In Type 2 Diabetes Mellitus (T2DM), insulin therapy is recommended when glycaemic control is suboptimal despite maximal oral agents and lifestyle modification. In spite of knowing the benefits, it has been reported that 71% of patients refuse insulin and the adherence rate ranges from 30-80%. Our study explored how patient-provider relationship affect insulin acceptance and adherence.
The study was conducted in two primary care clinics between September-2019 and January-2021. We used grounded theory approach in this qualitative research. Patients with T2DM on basal or premixed insulin were recruited using maximum variation sampling. Data was collected using semi-structured in-depth interviews until data saturation and transcribed verbatim for analysis using constant comparison and synthesis.
Twenty-one participants (mean age 61) with different level of diabetes control and adherence were recruited. Four themes that emerged were:1) patient-provider interaction, 2) psychological fears, 3) practical skills and knowledge and 4) follow up care. Trust in doctors, provider’s communication skills, patient-centred decision making and continuity of care positively influenced insulin acceptance and adherence. Conversely, fear of being judged by the provider hindered open communication around non-adherence. Demonstration of insulin pen by the nurses helped in addressing patient’s injection related fears.
Findings from this study suggest strategies to reduce insulin refusal and improve insulin adherence by enhancing patient-provider interactions. It is recommended to approach non-adherence in a non-judgemental or problem solving manner, ensure continuity of care through team- based care and involve trained nurses in addressing patient’s barriers towards insulin. Future research on provider’s view may be considered.