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 in general practice: A qualitative and simulation study. (Preprint)

Abstract

Up to half of children with new onset type 1 diabetes present to hospital in diabetic ketoacidosis, a life-threatening condition which can develop as a result of diagnostic delay. Three quarters of Australian children visit their general practitioner (GP) the week prior to presenting to hospital with diabetic ketoacidosis. Our prototype, DIRECT-T1DM, is an electronic clinical decision support tool that promotes immediate point of care testing in general practice to confirm suspicion of diabetes. This avoids laboratory testing, which has been documented internationally as a cause of diagnostic delay.

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.

Four GPs, a paediatric endocrinologist and a PhD candidate were involved in conceptualising the DIRECT-T1DM prototype, which was developed at The Department of General Practice and Primary Care at The University of Melbourne. Six GPs were recruited via convenience sampling to evaluate the tool. The study involved three phases: (1) a pre-simulation interview; (2) simulated clinical scenarios, and (3) a post-simulation 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 utilizing CFIR as the underlying framework.

Major themes were identified among three domains and eight constructs of the CFIR: (1) Outer setting: Time pressure, difficulty in diagnosing paediatric type 1 diabetes, and secondary care considerations shaped GP needs in relation to DIRECT-T1DM. (2) Inner setting: DIRECT-T1DM fits within existing workflows, has a high relative priority due to its importance in patient safety, and GPs exhibited high tension for change. (3) Innovation: Design recommendations included increased alarmist colouring, font style and bolding, specific language, information and guidelines, and inclusion of patient information sheets.

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.

Not applicable to this investigation.