چکیده (انگلیسی):

Background:The majority of care for people with type 2 diabetes occurs in general practice, however when
insulin initiation is required it often does not occur in this setting or in a timely manner and this may have
implications for the development of complications. Increased insulin initiation in general practice is an important
goal given the increasing prevalence of type 2 diabetes and a relative shortage of specialists. Coordination between
primary and secondary care, and between medical and nursing personnel, may be important in achieving this.
Relational coordination theory identifies key concepts that underpin effective interprofessional work:communication
which is problem solving, timely, accurate and frequent andrelationships between professional roles which are
characterized by shared goals, shared knowledge and mutual respect. This study explores roles and relationships
between health professionals involved in insulin initiation in order to gain an understanding of factors which may
impact on this task being carried out in the general practice setting.
Method:21 general practitioners, practice nurses, diabetes nurse educators and physicians were purposively
sampled to participate in a semi-structured interview. Transcripts of the interviews were analysed using framework
analysis.
Results:There were four closely interlinked themes identified which impacted on how health professionals worked
together to initiate people with type 2 diabetes on insulin: 1. Ambiguous roles; 2. Uncertain competency and
capacity; 3. Varying relationships and communication; and 4. Developing trust and respect.
Conclusions:This study has shown that insulin initiation is generally recognised as acceptable in general practice.
The role of the DNE and practice nurse in this space and improved communication and relationships between
health professionals across organisations and levels of care are factors which need to be addressed to support this
clinical work. Relational coordination provides a useful framework for exploring these issues.