Roles and relationships between health professionals involved in insulin initiation for people with type 2 diabetes in the general practice setting: a qualitative study drawing on relational coordination theory
Open accessAbstract
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 and relationships 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.
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The quality of diabetes care is compromised by time constraints and fragmented care.
“The quality of care is also compromised by time constraints and fragmented care [4].”
From Effect of virtual care in type 2 diabetes management – a systematic umbrella review of systematic reviews and meta-analysis (2025) · cites this paper as [4]
The Results (Uncertain competency and capacity; page unavailable) identify inadequate time for practice nurses as a safety concern in insulin initiation. The Results (Varying relationships and communication; page unavailable) describe poor communication across providers, and the Conclusion says barriers to coordination may harm patients. These findings support the concern, but the paper focuses on insulin initiation in general practice rather than establishing that time constraints and fragmented care compromise diabetes care generally. (LLM, conf=0.84)
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“This tension, which emerged in our early qualitative work, centered on perceptions that the professional expertise and scope of practice of DNEs was being challenged by the new model for insulin initiation in general practice (27).”
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The Role of Health Professionals in Managing Type 2 Diabetes Mellitus in Community: A Scoping ReviewPreprint
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“13,14 As specialists in their field, CDEs’ knowledge and skills in diabetes education, insulin initiation, and titration are often superior to that of GPs and health professionals recognize that insulin initiation in the primary care setting should be supported by a CDE.”
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- Authors
- Manski-Nankervis, J.-A., Furler, J., Blackberry, I., Young, D., O’Neal, D., & Patterson, E.
- Affiliations
- The University of Melbourne (AU)
- Corresponding author
- Manski-Nankervis, Jo-Anne
- Venue
- BMC Family Practice
- Published
- 2014-01-31
- Volume
- 15
- Issue
- 1
- Pages
- 20-20
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC3909758
- OpenAlex
- W1963682061
- Cited by
- 41
- References
- 54
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 2 · 2020: 3 · 2019: 4 · 2018: 2 · 2017: 9 · 2016: 2 · 2015: 3 · 2014: 2 · 2013: 1
- FWCI
- 9.66
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Family Practice (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Funders
- Royal Australian College of General Practitioners
- RACGP Foundation
- National Health and Medical Research Council
- Topics
- Health Sciences › Health Professions › General Health Professions › Interprofessional Education and Collaboration
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Keywords
- insulin initiation, type 2 diabetes, general practice, relational coordination theory, interprofessional collaboration, practice nurses, diabetes nurse educators, general practitioners, professional roles, communication between health professionals, trust and respect, primary care
- MeSH terms
- Diabetes Mellitus, Type 2, Female, Humans, Insulin, Interprofessional Relations, Male, Nursing, Patient Care Team, Professional Role, Qualitative Research, General Practice
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