TY  - JOUR
AU  - Beccia, Chiara
AU  - Hunter, Barbara
AU  - Manski-Nankervis, Jo-Anne
AU  - White, Mary
PY  - 2024
DA  - 2024/9/23
TI  - 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: Qualitative Interview Study Among General Practitioners
JO  - JMIR Form Res
SP  - e60411
VL  - 8
KW  - type 1 diabetes
KW  - digital health innovation
KW  - clinical decision support tool
KW  - diabetes
KW  - acceptability
KW  - feasibility
KW  - diagnosis
KW  - child
KW  - children
KW  - youth
KW  - qualitative and simulation study
KW  - hospital
KW  - diabetic ketoacidosis
KW  - diagnostic delay
KW  - Australian
KW  - Australia
KW  - video recorded
KW  - audio recorded
KW  - screen recorded
KW  - video
KW  - videos
KW  - patient
KW  - patients
AB  - Background: Up to half of the children with new-onset type 1 diabetes present to the hospital with diabetic ketoacidosis, a life-threatening condition that can develop because of diagnostic delay. Three-quarters of Australian children visit their general practitioner (GP) the week before presenting to the hospital with diabetic ketoacidosis. Our prototype, DIRECT-T1DM (Decision-Support for Integrated, Real-Time Evaluation and Clinical Treatment of Type 1 Diabetes Mellitus), is an electronic clinical decision support tool that promotes immediate point-of-care testing in general practice to confirm the suspicion of diabetes. This avoids laboratory testing, which has been documented internationally as a cause of diagnostic delay. Objective: 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. Methods: In total, 4 GPs, a pediatric endocrinologist, and a PhD candidate were involved in conceptualizing the DIRECT-T1DM prototype, which was developed at the Department of General Practice and Primary Care at the University of Melbourne. Furthermore, 6 GPs were recruited via convenience sampling to evaluate the tool. The study involved 3 phases: a presimulation interview, simulated clinical scenarios, and a postsimulation 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 using CFIR as the underlying framework. Results: Major themes were identified among three domains and 7 constructs of the CFIR: (1) outer setting—time pressure, difficulty in diagnosing pediatric type 1 diabetes, and secondary care considerations influenced GPs’ needs regarding DIRECT-T1DM; (2) inner setting—DIRECT-T1DM fits within existing workflows, it has a high relative priority due to its importance in patient safety, and GPs exhibited high tension for change; and (3) innovation—design recommendations included altering coloring to reflect urgency, font style and bolding, specific language, information and guidelines, and inclusion of patient information sheets. Conclusions: 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. 
SN  - 2561-326X
UR  - https://formative.jmir.org/2024/1/e60411
UR  - https://doi.org/10.2196/60411
DO  - 10.2196/60411
ID  - info:doi/10.2196/60411
ER  -