Barriers and facilitators to accessing insulin pump therapy by adults with type 1 diabetes mellitus: a qualitative study

Abstract

Aims Uptake of continuous subcutaneous insulin infusion (CSII) by people with diabetes (PwD) in Ireland is low and exhibits regional variation. This study explores barriers and facilitators to accessing CSII by adults with Type 1 diabetes mellitus. Research design and methods A qualitative study employing focus groups with adults with Type 1 diabetes mellitus (n = 26) and semi-structured interviews with health care professionals (HCP) and other key stakeholders (n = 21) was conducted. Reflexive thematic analysis was used to analyze data, using NVivo. Results Four main themes comprising barriers to or facilitators of CSII uptake were identified. These included: (1) awareness of CSII and its benefits, (2) the structure of diabetes services, (3) the capacity of the diabetes service to deliver the CSII service, and (4) the impact of individuals' attitudes and personal characteristics-both PwD, and HCP. Each of these themes was associated with a number of categories, of which 18 were identified and explored. If the structure of the health-service is insufficient and capacity is poor (e.g., under-resourced clinics), CSII uptake appears to be impacted by individuals': interest, attitude, willingness and motivation, which may intensify the regional inequality in accessing CSII. Conclusions This study identified factors that contribute to gaps in the delivery of diabetes care that policy-makers may use to improve access to CSII for adult PwD. KeywordsType 1 diabetes • Insulin pumps • Continuous subcutaneous insulin infusion • Medical device • Diabetes technology • Health-services research • Qualitative research This article belongs to the topical collection Health Education and Psycho-Social Aspects. Managed by Massimo Porta and Marina Trento.

Youth and non‐European ethnicity are associated with increased loss of publicly funded insulin pump access in New Zealand people with type 1 diabetes

“…Similar findings are seen in international data from Canada 14 and Germany 15 . The reasons for these inequities remain largely speculative, but commencing CSII requires resources, time, staff expertise and adequate education and support for people with diabetes, 16 and deficits in any of these areas are likely to contribute.…”

“…There are likely multiple contributing factors to this finding. Many factors influencing uptake have been addressed in previous qualitative work, 16 with many likely applicable to losing access too. Additionally, we hypothesise that in part, the current PHARMAC public funding criteria 17 particularly in limiting access to CSII based on less healthy or deteriorating glycaemic control may be a further contributor to this increasing disparity and disadvantage.…”

“…Disparity in CSII cessation by youth aged 10–29 is also seen. Again, among other factors (which could include personal preferences in this age group 16 ), the PHARMAC criteria focusing on the cessation of consumable funding as a consequence of deteriorating glycaemic control is likely to be an additional contributing factor. This age bracket is well known to experience deteriorations in glycaemic control due to both physiological and psychological factors when compared to childhood and adult data irrespective of insulin therapy modality 28,29 .…”

Shaping Workflows in Digital and Remote Diabetes Care During the COVID-19 Pandemic via Service Design: Prospective, Longitudinal, Open-label Feasibility Trial

“…However, it is worth acknowledging that although the use of diabetes technology is clearly associated with countries' local reimbursement strategies or health insurance plans [57], diabetes technology uptake is heterogeneous in countries that offer full reimbursements. Individual aspects such as personal attitudes or interests (ie, those of people with diabetes and, more importantly, HCPs), awareness, structure, and capacity are insurance-related determinants to improving the accessibility of diabetes technology [58]. Thus, we are aware that our proposed model may not be suitable for all pediatric diabetes clinics.…”

Cost considerations for adoption of diabetes technology are pervasive: A qualitative study of persons living with type 1 diabetes and their families

“…15 In addition, a study evaluating insulin pump uptake in Ireland demonstrated that reimbursement alone as a cost consideration does not fully account for uptake of insulin pumps. 11 Qualitative studies are foundational in understanding the lived experience of type 1 diabetes as well as factors surrounding diabetes technology uptake and use. 10,16 These evaluations are particularly important when aiming to improve diabetes technology uptake as clinicians often misidentify or over identify barriers to diabetes technology use, which can lead to inadvertent gatekeeping and/or irrelevant solutions that are out of touch with the person's actual barriers.…”