Exploring the User Acceptability and Feasibility of a Clinical Decision Support Tool Designed to Facilitate Timely Diagnosis of New-Onset Type 1 Diabetes in Children: Qualitative Interview Study Among General Practitioners.
JMIR Form Res
; 8: e60411, 2024 Sep 23.
Article
in En
| MEDLINE
| ID: mdl-39312767
ABSTRACT
BACKGROUND:
Up to half of the children with new-onset type 1 diabetes present to the hospital with diabetic ketoacidosis, a life-threatening condition that can develop because of diagnostic delay. Three-quarters of Australian children visit their general practitioner (GP) the week before presenting to the hospital with diabetic ketoacidosis. Our prototype, DIRECT-T1DM (Decision-Support for Integrated, Real-Time Evaluation and Clinical Treatment of Type 1 Diabetes Mellitus), is an electronic clinical decision support tool that promotes immediate point-of-care testing in general practice to confirm the suspicion of diabetes. This avoids laboratory testing, which has been documented internationally as a cause of diagnostic delay.OBJECTIVE:
In this investigation, we aimed to pilot and assess the feasibility and acceptability of our prototype to GP end users. We also explored the challenges of diagnosing type 1 diabetes in the Australian general practice context.METHODS:
In total, 4 GPs, a pediatric endocrinologist, and a PhD candidate were involved in conceptualizing the DIRECT-T1DM prototype, which was developed at the Department of General Practice and Primary Care at the University of Melbourne. Furthermore, 6 GPs were recruited via convenience sampling to evaluate the tool. The study involved 3 phases a presimulation interview, simulated clinical scenarios, and a postsimulation interview. The interview guide was developed using the Consolidated Framework for Implementation Research (CFIR) as a guide. All phases of the study were video, audio, and screen recorded. Audio recordings were transcribed by the investigating team. Analysis was carried out using CFIR as the underlying framework.RESULTS:
Major themes were identified among three domains and 7 constructs of the CFIR (1) outer setting-time pressure, difficulty in diagnosing pediatric type 1 diabetes, and secondary care considerations influenced GPs' needs regarding DIRECT-T1DM; (2) inner setting-DIRECT-T1DM fits within existing workflows, it has a high relative priority due to its importance in patient safety, and GPs exhibited high tension for change; and (3) innovation-design recommendations included altering coloring to reflect urgency, font style and bolding, specific language, information and guidelines, and inclusion of patient information sheets.CONCLUSIONS:
End-user acceptability of DIRECT-T1DM was high. This was largely due to its implications for patient safety and its "real-time" nature. DIRECT-T1DM may assist in appropriate management of children with new-onset diabetes, which is an uncommon event in general practice, through safety netting.Key words
Australia; Australian; acceptability; audio recorded; child; children; clinical decision support tool; diabetes; diabetic ketoacidosis; diagnosis; diagnostic delay; digital health innovation; feasibility; hospital; patient; patients; qualitative and simulation study; screen recorded; type 1 diabetes; video; video recorded; videos; youth
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Feasibility Studies
/
Decision Support Systems, Clinical
/
Qualitative Research
/
Diabetes Mellitus, Type 1
/
General Practitioners
Limits:
Adult
/
Child
/
Female
/
Humans
/
Male
Country/Region as subject:
Oceania
Language:
En
Journal:
JMIR Form Res
Year:
2024
Document type:
Article