by:

AILEEN TAY CHOO AI KHAIRUNNISA ZAMRI

MARILYN TAN MAY YEEN

INSULIN-RELATED KNOWLEDGE AMONG HEALTHCARE PROVIDERS IN

HOSPITAL SULTANAH NUR ZAHIRAH

PI :

IDA AFDZAN BINTI AWANG @ ROZALLI

Co - PI :

NOOR RODHIAH BINTI ABDUL RAHMAN

• The prevalence of diabetes mellitus is increasing around the world resulting in higher healthcare system costs and substantial premature mortality (Jill et al., 2012)

• The progressive decline in beta cell function ultimately renders oral agents ineffective and the majority of patients with diabetes will require exogenous insulin treatment (Vincent P et al., 2008)

• Insulin is widely accepted as the most effective treatment option available in diabetes management to achieve treatment targets for glycemic control (Schreiber SA et al., 2008).

INTRODUCTION

• This study will help healthcare provider to identify their level of insulin related knowledge and help the future researcher as a guide.

• Identification of areas of knowledge among different professions could provide a vital step towards implementation of educational diabetes programme and improvement of care standards for diabetes patients.

SIGNIFICANCE OF STUDY

• To evaluate insulin-related knowledge among different professions in HSNZ

• To identify the relationship between professional categories in HSNZ with insulin-related knowledge

• To identify the relationship between staff’s comfortability in managing diabetes with insulin related knowledge

• To identify the relationship between working experience with insulin-related knowledge

OBJECTIVES OF STUDY

• Material:

- A validated questionnaire (self-answered but guided)

used in a similar study by Derr et al. (2007)

- Consists of 16 multiple-choice questions with single best

answer (Question 5 – 20)

- questionnaire

MATERIALS & METHODS

• Method:

- Observational study

- Convenient sampling for all professional categories

- Location of survey :

* Neurology Clinic / Auditorium(for medical officers/ &

nurses)

* Main Pharmacy (for pharmacists)

- Duration of survey : May – July 2014

- Participants were not allowed to refer to any reference

materials or consult others

MATERIALS & METHODS

• INCLUSION:

All staffs who were attending medical CME

Medical officers

Nurses

Pharmacists

INCLUSION CRITERIA

SURVEY WORK FLOW Questionnaire comprised of 20 multiple-choice questions.

1) 4 background-related question and

2) 16 knowledge-based questions

-7 questions on insulin nomenclatures & characteristics

-9 questions on insulin use.

Questionnaires were distributed to respondents during medical CME sessions

All questionnaires were completed in one sitting

Completed questionnaires were scored manually

STUDY ANALYSIS

•Statistical analysis were performed using SPSS Version 17.0

•A value of p<0.05 was considered as statistically significant

DATA ANALYSIS & RESULTS

Statistical Test Significance value

Normality test

- Shapiro-Wilk

Population distribution p > 0.05

-the data is normal

One-way

analysis of

variance

(ANOVA)

Association between

scores of various

categories

Significant when p<0.05

-Professional categories

-Comfort levels

-Working experiences

A. Study population – Gender and Profession category(n=197)

Figure 1

DEMOGRAPHIC DATA

21

79

GENDER (%)

Male

Female

Figure 2

31

24

45 Medical officer

Pharmacist

Nurse

PROFESSION CATEGORY (%)

DEMOGRAPHIC DATA– COMFORT LEVEL

Figure 3

Reported comfort levels in managing diabetes

STUDY RESULTS- LEARNING MEDIUM A. Learning medium among medical doctors, nurses and pharmacists

Table 1

STUDY RESULTS – KNOWLEDGE SCORES B. Mean scores according to professional categories (between groups)

Table 2

Professional category

Mean scores

Insulin nomenclatures &

characteristics

Insulin use

Total score

Medical doctors 41.06 40.43 41.73

Nurses 27.81 35.98 34.29

Pharmacists 62.24 50.60 51.00

P value < 0.05 < 0.05 <0.05

There were statistically significant differences between profession

categories for both scores on insulin nomenclatures & characteristics (p <

0.05) and insulin use (p < 0.05)

* Statistical test done using One-way ANOVA

C. Comparison between comfort levels and knowledge scores

There was no significant difference between reported comfort levels and

insulin related knowledge (p >0.05)

STUDY RESULTS – COMFORTABILITY

Table 4

STUDY RESULTS – WORKING EXPERIENCE

Working experience

(years)

Mean scores

Insulin nomenclatures &

characteristics

Insulin use

0-5 41.06 42.43

6-10 37.12 38.50

11-20 33.50 36.21

21-30 49.50 33.00

p value > 0.05 > 0.05

D. Comparison between working experience and knowledge scores

(between groups)

Table 5

There was no significant difference between insulin related knowledge with working years among all profession categories (p>0.05)

* Statistical test done using One-way ANOVA

Profession category

Working experience

(years)

Mean scores

P value Insulin

nomenclatures &

chracteristics

Insulin

use

Medical officer

0-5 36.98 38.30

p < 0.05 6-10 39.0 33.0

11-20 71.00 55.00

21-30 42.00 -

Nurse

0-5 25.06 41.80

p > 0.05 6-10 29.29 38.79

11-20 26.88 29.94

21-30 57.00 33.00

Pharmacist

0-5 61.81 52.25

p > 0.05 6-10 63.80 44.00

E. Comparison between working experience of different profession

categories and knowledge scores (within groups)

Table 6

* Statistical test done using One-way ANOVA

RESULTS SUMMARY

Statistical Tests P value

Professional category vs scores P <0.05

Comfort levels vs scores P>0.05

Working experience vs scores P>0.05

•Working experience (medical officer) vs.

scores

P <0.05

•Working experience (nurse) vs. scores P>0.05

•Working experience (pharmacist) vs.

scores

P>0.05

• It was found that there were significant differences (p<0.05) in insulin – related knowledge among different professions in HSNZ.

• Pharmacists scored highest in both categories (insulin nomenclatures & characteristics - 62.24% and insulin use-50.6%) . This may be caused by their theoretical and practical training in medication use and better exposures to insulin therapy

• This finding is similar to other studies done by Melvin et al. (2013).

• Medical doctors are having similar score in both categories of insulin knowledge (insulin nomenclatures & characteristics- 41.06% and insulin use-40.03%).

DISCUSSIONS

• Nurses scored higher percentage in areas of insulin use(mean score 35.98%) compared to insulin nomenclatures & characteristics (mean score 27.81%)

• This difference reflects the role of the nurses in handling and using insulins in the medical wards.

• However, a study done by Derr et al. (2007) found that nurses scored higher in the latter aspect.

DISCUSSIONS

• Only 34% of participants reported “very comfortable” in managing patients with DM although majority are directly involved in patient management.

• There was no association between their comfort levels in managing diabetes and knowledge scores (p >0.05) although insulin is very commonly used in the treatment of hospitalized patients

• These results were in concordance to other studies by Derr et al. (2007) and Melvin et al. (2013).

DISCUSSIONS

• This study also showed there was no association between working experience with their insulin-related knowledge when compared among all profession categories(p>0.05).

• This shows that length of working experience do not equate the levels of insulin related knowledge among healthcare providers.

• However, there was an association between working experience of medical officers in both knowledge areas when data was analyzed within groups (p< 0.05).

• So far, there were no other studies that showed association between working experience and insulin-related knowledge.

DISCUSSIONS

• The level of insulin related knowledge is different among medical officers, pharmacists and nurses in HSNZ. Pharmacist scored highest followed by medical officers and lowest score was achieved by nurses.

• Insulin – related knowledge was associated with profession categories in both insulin nomenclatures & characteristics and insulin use.

• However, there was no association between insulin-related knowledge and reported comfort levels or working experience of all groups

CONCLUSIONS

• Besides continuous medical education, more efforts should be done to facilitate the communication among medical officers, pharmacists and nurses.

• Interrelated roles among healthcare providers and specific skill set are essential for safe insulin use to achieve better glycaemic control and desirable clinical outcome.

RECOMMENDATION

1. Kamal M, El-Deirawi and Nashat Zuraikat. Registered nurses’ actual and perceived knowledge

of diabetes mellitus. Journal of vascular dressing 2011: 19:95-100

2. Melvin KSL, Zhenghong L, Timothy PLQ, Daniel EKC, Insulin related knowledge among

healthcare professionals at a tertiary hospitals. Diabetes Spectrum; Summer 2013: 26, 3.

3. Practical Guide to Insulin Therapy in Type 2 Diabetes Mellitus. 2011.

4. Rachel L. Derr, MD; Mala S. Sivanandy, MD; Lauren Bronich-Hall, RD, CDE; and Annabelle

Rodriguez, MD. Insulin-Related Knowledge Among Health Care Professionals in Internal

Medicine. Diabetes Spectrum, 20(3), 2007.

5. Roman Trepp, Tonio Wille, Thomas Wieland, Walter H. Reinhart. Diabetes-related knowledge

among medical and nursing house staff. Swiss Med Wkly 2 010 ; 14 0 ( 2 5 – 2 6 ) : 3 7 0 – 3 7

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