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Population Screening for Type 1 Diabetes in Pediatrics via Well-Child Visits: Barriers and Facilitators to
Christie Gilbert Klaczko1,2, Nicole Walters1, Alexis E Blackburn3
1Department of Genomic Health, Geisinger, Danville, PA.
Insights
Screening for type 1 diabetes (T1D) during well-child visits is acceptable to parents and clinicians. Addressing barriers like cost and education is key for successful T1D screening integration into primary care.
Area of Science:
- Endocrinology
- Pediatrics
- Public Health
Background:
- Type 1 diabetes (T1D) screening offers early detection, preventing complications like diabetic ketoacidosis and enabling access to new therapies.
- Population-wide T1D screening discussions are ongoing, with primary care visits proposed as a scalable method.
- Understanding multilevel barriers and facilitators is crucial for implementing T1D autoantibody screening in primary care.
Purpose of the Study:
- To explore barriers and facilitators of type 1 diabetes autoantibody screening during well-child visits.
- To assess the acceptability, appropriateness, and feasibility of primary care-based T1D screening.
Main Methods:
- Mixed-methods approach using semi-structured interviews with parents, clinicians, and health insurers.
- Survey deployed to pediatric primary care clinicians assessing implementation measures.
- Qualitative data analyzed through double coding with an adapted a priori codebook.
Main Results:
- Most parents and surveyed clinicians found T1D screening acceptable and appropriate.
- Identified barriers include lack of education, blood draw concerns, costs, scheduling, and fear of results.
- Facilitators include education, cost reduction, convenient screening, supportive guidelines, and institutional backing.
Conclusions:
- Integrating primary care into population screening models for type 1 diabetes is necessary.
- Successful T1D screening via primary care well-child visits depends on addressing identified barriers and promoting facilitators.
Objective:
Screening for type 1 diabetes provides an opportunity to identify those with presymptomatic, early-stage disease, enabling increased monitoring to prevent diabetic ketoacidosis and facilitating access to emerging therapies. Given potential benefits, discussions about population-wide type 1 diabetes screening are ongoing. Routine primary care visits could offer a scalable approach to such screening. We used mixed methods to explore multilevel barriers to and facilitators of type 1 diabetes autoantibody screening at well-child visits and, more broadly, the acceptability, appropriateness, and feasibility of such a screening approach.
Research Design And Methods:
Semi-structured interviews were completed with parents, clinicians, and health insurers. Transcripts were double coded using an iteratively adapted a priori codebook. A survey leveraging the validated Acceptability of Implementation, Intervention Appropriateness, and Feasibility of Intervention Measures instruments was deployed to assess pediatric primary care clinician perspectives.
Results:
A total of 26 parents, 10 clinicians (endocrinologists and pediatricians), and two health insurers participated in interviews, and 15 pediatricians participated in the survey. Most parents interviewed and clinicians surveyed found type 1 diabetes screening acceptable and appropriate. Parents noted lack of education, need for a blood draw, costs, difficulty scheduling, and fear of results as barriers. Clinicians reported barriers including parental views on blood draws and clinician time. Insurers described lack of insurance coverage as a barrier. Facilitators across constituents included education, reduced costs, convenient screening, guidelines supporting screening, and institutional support.
Conclusion:
If population screening for type 1 diabetes is pursued, models that integrate primary care will be needed. Screening for type 1 diabetes through primary care well-child visits could enable high adoption if implementation strategies adequately address described barriers and promote facilitators.
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