La Trobe
Guiding glucose management discussions among adults with type 2 diabetes in general practice.pdf (296.82 kB)
Download file

Guiding glucose management discussions among adults with type 2 diabetes in general practice: Development and pretesting of a clinical decision support tool prototype embedded in an electronic medical record

Download (296.82 kB)
journal contribution
posted on 03.02.2021, 01:14 by Breanne Kunstler, J Furler, E Holmes-Truscott, H McLachlan, D Boyle, S Lo, J Speight, D O'Neal, R Audehm, G Kilov, JA Manski-Nankervis
© Breanne E Kunstler, John Furler, Elizabeth Holmes-Truscott, Hamish McLachlan, Douglas Boyle, Sean Lo, Jane Speight, David O'Neal, Ralph Audehm, Gary Kilov, Jo-Anne Manski-Nankervis. Originally published in JMIR Formative Research (http://formative.jmir.org), 02.09.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on http://formative.jmir.org, as well as this copyright and license information must be included. Background: Managing 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. Objective: This 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. Methods: The 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. Results: Clinicians 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. Conclusions: GlycASSIST 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.

History

Publication Date

02/09/2020

Journal

JIMR Formative Research

Volume

4

Issue

9

Article Number

e17785

Pagination

14p. (p. 1-14)

Publisher

JMIR Publications

ISSN

2561-326X

Rights Statement

The Author reserves all moral rights over the deposited text and must be credited if any re-use occurs. Documents deposited in OPAL are the Open Access versions of outputs published elsewhere. Changes resulting from the publishing process may therefore not be reflected in this document. The final published version may be obtained via the publisher’s DOI. Please note that additional copyright and access restrictions may apply to the published version.

Usage metrics

Categories

Licence

Exports