Abstract
Introduction: Type 1 diabetes (T1D) is a life-long condition typically diagnosed in childhood. Clinical practice guidelines recommend comprehensive multidisciplinary team-based (MDT) care led by paediatric endocrinologists. However, experiences and opinions of health professionals about the implementation of T1D MDTs in Australia are currently unknown.
Aims: To describe health service teams caring for children and youth with T1D in Australia, and to identify opportunities for service improvements from providers’ perspectives.
Methods: Our mixed methods study included a survey co-designed with clinicians and consumers, and semi-structured interviews. Survey questions covered clinic setting, modes of care delivery, team composition and outreach. We thematically analysed interview transcripts using a hybrid inductive/deductive approach.
Results: Thirty-two leaders of T1D services completed the survey: seven participated in interviews. Respondents were from metropolitan (n=16) and regional/rural areas (n=16) across all Australian states and territories. T1D services were multidisciplinary and commonly included dieticians (n=29, 94%), nurse diabetes educators (n=22, 71%), and general paediatricians (n=21, 68%). Eight (29%) services had a dedicated psychologist. A quarter (25%) of regional/rural services had a paediatric endocrinologist compared with 100% of city services (z=4.2843; P<0.00001). All services offered telehealth consultations. Interviews revealed that services placed high value on having established cohesive teams skilled in T1D. Service leaders had concerns regarding workforce capacity and shortages, limited access to psychologists, inequitable access to continuous glucose monitors and insulin pumps, and limited links with general practitioners. Almost two-thirds (59%) of services also cared for children with Type 2 Diabetes (T2D).
Conclusion: This mixed-methods study is the first Australia-wide exploration of T1D models of care that describes care provision from the clinicians’ perspectives. There is a need to address current gaps to progressing towards achieving the recommended MDT models of care for T1D in Australia. As the rates of T2D increase among children, services may need additional resources.