How do family physicians working in primary care decide to switch insulin treatment from oral antidiabetics for their TYPE 2 diabetes mellitus patients?

Background: Recently, chronic diseases such as diabetes mellitus is a major health problem; diagnosis, treatment and follow-up is performed best in primary care, family physicians should be effective at every stage of disease. Not to begin insulin therapy on time could cause unsatisfied patient, inappropriate use of health services and lead problems in terms of cost. In our thesis, we want to investigate how the Family Physicians (FPs) decide to begin the insulin therapy for their patients whom diagnosed Type 2 Diabetes Mellitus. Method: Our study is planned in combined method, including qualitative and quantitative studies. Theory development method which is a kind of qualitative research methods is used and to aim the maximum diversity with a total of 12 family health care centers, with 42 FPs focus group discussions were conducted. With results of qualitative study a Likert type questionnaire made and performed to 400 FPs working in İzmir province. Results: FPs mentioned the management of Type 2 DM patients as their duty nevertheless they have trouble with starting insulin therapy for several reasons. For example; the FPs related reasons (lack of knowledge, experience or confidence, ethical concerns, fear about complications, time pressure), the reasons inflicted from patients (false believes about insulin, problems of practice) and problems about legislative regulation could be mentioned. The second part of our study is related to the lack of prominent obstacles of working conditions. Discussion and Conclusion: FPs are agreed on the follow-up of Type2 DM patients should be performed at primary care, need about closing the gap of education, provision of nurse whom educated about DM, reduction of the registered population, improvement of working conditions and the payment conditions of the regulation of obstacles associated with insulin therapy. They think that if there is a continuous consultant unit they won't even refer the patients to a higher step for insulin therapy needs and could regulate the patients' treatment. In addition, they think that the value given to healthcare workers should be increased, health ministry should inform media correctly and should use media to prevent the healthcare workers from negative attitudes.