• Tricia Tang, Danielle Hessler, William H Polonsky, Lawrence Fisher, Beverly Reed, Tanya Irani, Urvi Desai, and Magaly Perez-Nieves.
• From the University of British Columbia, Vancouver, Canada (TT); University of California, San Francisco, CA (DH, LF); Behavioral Diabetes Institute, San Diego, CA (WHP); University of California, San Diego, CA (WHP); Eli Lilly and Company, Indianapolis, IN (BR, MP-N); Eli Lilly and Company, Canada (TI); Analysis Group, Inc., Boston, MA (UD).
• J Am Board Fam Med. 2020 Mar 1; 33 (2): 198-210.

PurposeTo identify specific actions and characteristics of health care providers (HCPs) in the United States and Canada that influenced patients with type 2 diabetes who were initially reluctant to begin insulin.MethodsPatients from the United States (n = 120) and Canada (n = 74) were recruited via registry, announcements, and physician referrals to complete a 30-minute online survey based on interviews with patients and providers regarding specific HCP actions that contributed to the decision to begin insulin.ResultsThe most helpful HCP actions were patient-centered approaches to improve patients' understanding of the injection process (ie, "My HCP walked me through the whole process of exactly how to take insulin" [helped moderately or a lot, United States: 79%; Canada: 83%]) and alleviate concerns ("My HCP encouraged me to contact his/her office immediately if I ran into any problems or had questions after starting insulin" [United States: 76%; Canada: 82%]). Actions that were the least helpful included referrals to other sources (ie, "HCP referred patient to a class to help learn more about insulin" [United States: 40%; Canada: 58%]).ConclusionsThe study provides valuable insight that HCPs can use to help patients overcome psychological insulin resistance, which is a critical step in the design of effective intervention protocols.© Copyright 2020 by the American Board of Family Medicine.

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