Abstract
BackgroundManaging type 2 diabetes (T2D) requires progressive lifestyle changes and, sometimes, pharmacological treatment intensification. General practitioners (GPs) are integral to this process but can find pharmacological treatment intensification challenging because of the complexity of continually emerging treatment options.ObjectiveThis study aimed to use a co-design method to develop and pretest a clinical decision support (CDS) tool prototype (GlycASSIST) embedded within an electronic medical record, which uses evidence-based guidelines to provide GPs and people with T2D with recommendations for setting glycated hemoglobin (HbA1c) targets and intensifying treatment together in real time in consultations.MethodsThe literature on T2D-related CDS tools informed the initial GlycASSIST design. A two-part co-design method was then used. Initial feedback was sought via interviews and focus groups with clinicians (4 GPs, 5 endocrinologists, and 3 diabetes educators) and 6 people with T2D. Following refinements, 8 GPs participated in mock consultations in which they had access to GlycASSIST. Six people with T2D viewed a similar mock consultation. Participants provided feedback on the functionality of GlycASSIST and its role in supporting shared decision making (SDM) and treatment intensification.ResultsClinicians and people with T2D believed that GlycASSIST could support SDM (although this was not always observed in the mock consultations) and individualized treatment intensification. They recommended that GlycASSIST includes less information while maintaining relevance and credibility and using graphs and colors to enhance visual appeal. Maintaining clinical autonomy was important to GPs, as they wanted the capacity to override GlycASSIST’s recommendations when appropriate. Clinicians requested easier screen navigation and greater prescribing guidance and capabilities.ConclusionsGlycASSIST was perceived to achieve its purpose of facilitating treatment intensification and was acceptable to people with T2D and GPs. The GlycASSIST prototype is being refined based on these findings to prepare for quantitative evaluation.
Highlights
Type 2 diabetes (T2D) affects more than 420 million people worldwide [1]
GlycASSIST was perceived to achieve its purpose of facilitating treatment intensification and was acceptable to people with type 2 diabetes (T2D) and General practitioners (GPs)
The general target is glycated hemoglobin health care professionals (HCPs) (HbA1c) of ≤7% (53 mmol/mol), the Australian Diabetes Society and international guidelines suggest that targets need to be individualized based on several factors, including age, duration of diabetes, comorbidities, and risk of hypoglycemia [4,5,6]
Summary
In Australia, T2D affects 1.2 million people, amounting to more than Aus $6 (US $4.3) billion annually in direct and indirect health care costs [2]. In Australia, as in many countries, most clinical care of people with T2D is based on general practice or primary care [7]. Treatment intensification by general practitioners (GPs) can help people with diabetes achieve glycemic targets [8,9]. Barriers to GPs delivering evidence-based treatment intensification include lack of familiarity with clinical diabetes guidelines and the complex and rapidly changing treatment options for optimizing blood glucose levels (BGLs) [12,13,14]. General practitioners (GPs) are integral to this process but can find pharmacological treatment intensification challenging because of the complexity of continually emerging treatment options
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