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Health Service Leaders' Perspectives on Type 1 Diabetes Models of Care for Children and Young Adults in Australia: A
Yvonne Zurynski1, Carolynn L Smith1, Ann Carrigan1,2
1Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia, mq.edu.au.
Insights
This study surveyed Australian health professionals on Type 1 diabetes (T1D) care. Findings reveal gaps in multidisciplinary team (MDT) implementation, particularly in rural areas, highlighting needs for improved T1D management.
Area of Science:
- Pediatric Endocrinology
- Health Services Research
- Diabetes Management
Background:
- Type 1 diabetes (T1D) is a chronic condition diagnosed in childhood, necessitating comprehensive care.
- Clinical guidelines advocate for multidisciplinary teams (MDTs) led by pediatric endocrinologists for T1D management.
- The current landscape of T1D MDT implementation in Australia remains largely undocumented from a provider's viewpoint.
Purpose of the Study:
- To characterize the structure and composition of pediatric T1D healthcare teams across Australia.
- To identify areas for service enhancement from the perspective of healthcare providers.
- To understand the experiences of health professionals involved in T1D care delivery.
Main Methods:
- A mixed-methods approach was employed, co-designed with clinicians and consumers.
- Surveys were distributed to leaders of 32 T1D services across Australia, covering care delivery, team composition, and outreach.
- Semi-structured interviews were conducted, with thematic analysis applied to identify key insights.
Main Results:
- While most services included dietitians and nurse educators, only 29% had dedicated psychologists.
- Paediatric endocrinologist presence was universal in major cities but only 25% in regional/rural services.
- Service leaders expressed concerns about workforce shortages, limited psychologist access, and inequitable insulin pump access.
Conclusions:
- This study provides the first Australia-wide overview of T1D care models from a clinician's perspective.
- Significant gaps exist in achieving recommended MDT models for T1D care, particularly in regional and rural settings.
- Understanding current models is crucial for evaluating future impacts of policy, therapy, and demand shifts on pediatric T1D services.
Introduction:
Type 1 diabetes (T1D) is a lifelong condition typically diagnosed in childhood. Clinical practice guidelines recommend comprehensive multidisciplinary team (MDT)-based 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:
Mixed-methods study co-designed with clinicians and consumers, including a survey of clinic leaders and semi-structured interviews. Survey questions covered modes of care delivery, team composition and outreach. Interview transcripts were thematically analysed using a hybrid inductive/deductive approach.
Results:
Thirty-two T1D services leaders completed the survey; 16 were from major cities and 16 were from regional/rural areas across all Australian states and territories. The services provided care for ~51% of all <19-year-olds living with T1D. 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 major city services (χ2 = 18.355; p < 0.001). 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 insulin pumps and limited links with general practitioners.
Conclusion:
This mixed-methods study is the first Australia-wide exploration of T1D models of care that describes care provision from the clinicians' perspectives. A need exists to address current gaps to achieve the recommended MDT models of care for T1D. Understanding existing models of care will be essential to determine the future impacts of changes in policies, therapies and demands on paediatric T1D services.
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