Factors affecting prescription of sodium-glucose co-transporter 2 inhibitors in patients with type 2 diabetes mellitus with established cardiovascular disease/ chronic kidney disease in Hong Kong: a qualitative study

BMC Primary Care

Research

Ngai Mui Ng¹  Tsun Kit Chu¹  Yeung Shing Ng¹  Phyllis Lau² 

[1] Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong SAR, China;Department of General Practice, University of Melbourne, 780, Elizabeth Street, 3010, Melbourne, VIC, Australia;School of Medicine, Western Sydney University, Locked Bag 1797, 2751, Penrith, NSW, Australia;

关键词: Type 2 diabetes;    SGLT 2 inhibitors;    Cardiovascular;    Chronic kidney disease;    Primary care;    Qualitative study;   

DOI  :  10.1186/s12875-022-01928-z

 received in 2022-04-26, accepted in 2022-11-25,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundSodium-glucose co-transporter 2 inhibitors (SGLT2 I) has cardiorenal protective properties and are recommended for patients with diabetes and established atherosclerotic cardiovascular disease (ASCVD) and/or chronic kidney disease (CKD). Although cardiorenal complications are high in diabetes and pose a significant financial burden on the Hong Kong health care system, the use of SGLT2 I in these populations remains low. And yet this issue has not been explored in Hong Kong primary care. This study aimed to explore factors affecting primary care doctors’ prescribing of SGLT2 I in patients with diabetes and established ASCVD/CKD in Hong Kong.MethodsA phenomenological qualitative research using semi-structured interviews was conducted between January and May 2021 in one Hospital Authority cluster in Hong Kong. Purposive sampling was employed to recruit primary care doctors in the cluster. The Theoretical Domains Framework (TDF) underpinned the study and guided the development of the interview questions. Data was analysed using both inductive and deductive approaches. The Consolidated criteria for reporting qualitative research (COREQ) checklist was used to guide the reporting.ResultsInterviews were conducted with 17 primary care doctors. Four overarching themes were inductively identified: knowledge and previous practice patterns influence prescription, balancing risks and benefits, doctors’ professional responsibilities, and system barriers. The four themes were then deductively mapped to the nine specific domains of the TDF: knowledge; intention; memory; beliefs about capabilities; beliefs about consequences; goals; role and identity; emotion; and environmental constraints. Most interviewees, to varying extent, were aware of the cardio-renal advantages and safety profile of SGLT2 I but are reluctant to prescribe or change their patients to SGLT2 I because of their knowledge gap that the cardio-renal benefits of SGLT2 I was independent of glyacemic efficacy. Other barriers included their considerations of patients’ age and renal impairment, and patients’ perceptions and preferences.ConclusionsDespite evidence-based recommendations of the utilisation of SGLT2 I in patients with established ASCVD/CKD, the prescription behaviour among primary care doctors was affected by various factors, most of which were amendable. Our findings will inform the development of structured interventions to address these factors to improve patients’ cardio-renal outcomes.

【 授权许可】

CC BY   
© The Author(s) 2022