Background: Limited evidence exists on the effectiveness of external diabetes support provided by diabetes\r\nspecialists and community retail pharmacists to facilitate insulin-prescribing in family practice.\r\nMethods: A stratified, parallel group, randomized control study was conducted in 15 sites across Canada. Family\r\nphysicians received insulin initiation/titration education, a physician-specific ââ?¬Ë?report cardââ?¬â?¢ on the characteristics of\r\ntheir type 2 diabetes (T2DM) population, and a registry of insulin-eligible patients at a workshop. Intervention\r\nphysicians in addition received: (1) diabetes specialist/educator consultation support (active diabetes specialist/\r\neducator consultation support for 2 months [the educator initiated contact every 2 weeks] and passive consultation\r\nsupport for 10 months [family physician initiated as needed]); and (2) community retail pharmacist support (option\r\nto refer patients to the pharmacist(s) for a 1-hour insulin-initiation session). The primary outcome was the insulin\r\nprescribing rate (IPR) per physician defined as the number of insulin starts of insulin-eligible patients during the\r\n12-month strategy.\r\nResults: Consenting, eligible physicians (n = 151) participated with 15 specialist sites and 107 community\r\npharmacists providing the intervention. Most physicians were male (74%), and had an average of 81 patients with\r\nT2DM. Few (9%) routinely initiated patients on insulin. Physicians were randomly allocated to usual care (n = 78) or\r\nthe intervention (n = 73). Intervention physicians had a mean (SE) IPR of 2.28 (0.27) compared to 2.29 (0.25) for\r\ncontrol physicians, with an estimated adjusted RR (95% CI) of 0.99 (0.80 to 1.24), p = 0.96.\r\nConclusions: An insulin support program utilizing diabetes experts and community retail pharmacists to enhance\r\ninsulin prescribing in family practice was not successful. Too few physicians are appropriately intensifying diabetes\r\nmanagement through insulin initiation, and aggressive therapeutic treatment is lacking.
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