Facilitators and barriers to SGLT2i and GLP1a prescribing in Northern Ontario: a qualitative interview study

BackgroundOne in three adults in Ontario, Canada has type 2 diabetes, obesity, heart failure, or chronic kidney disease, and the prevalence is even higher in Northern Ontario. Sodium glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 analogues (GLP1a) are highly effective medications to treat these conditions, but prescribing rates in Northern Ontario are low. This study aimed to explore the facilitators and barriers to SGLT2i and GLP1a prescribing for adults living with and without diabetes in Northern Ontario. MethodsWe conducted virtual, semistructured interviews of clinicians (i.e., physicians, nurse practitioners, resident physicians) working in Northern Ontario, Canada between July 2024 and November 2024. Interview transcripts were thematically coded into categories based on the Theoretical Domains Framework (TDF). Findings were classified as either barriers or facilitators, and then grouped to identify major subthemes within the data. Subthemes were then further aggregated into themes and mapped onto the Capability, Opportunity, Motivation-Behaviour (COM-B) model for behaviour change. ResultsWe interviewed 25 clinicians, including eight physicians, eight resident physicians, and nine nurse practitioners caring for adults in Northern Ontario. Twenty-two of the interviews were held one-on-one and one was held as a co-interview with three participants. We identified five main barriers and five main facilitators to SGLT2i and GLP1a prescribing. The major barriers included: limited access to medications, patient challenges and competing demands, lack of familiarity, clinical identity, and prescribing inertia. Limited access to medications was a prominent theme with nested subthemes of high cost of medications for patients and insufficient compassionate drug programs to cover these costs. The major facilitators included: role as a clinician that follows the data, belief that SGLT2i/GLP1a use will improve patient outcomes, clinicians perceptions of patient openness to these drugs, comfort prescribing, and system and colleague supports. ConclusionOur findings provide useful insights to inform knowledge translation initiatives aimed at increasing the uptake of SGLT2i and GLP1a in Northern Ontario.