Division of Population Health Sciences, RCSI: University of Medicine and Health Sciences, Beaux Lane House, Mercer Street Lower, Dublin 2, Dublin, Ireland.
Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands.
Acta Diabetol. 2021 Jan;58(1):93-105. doi: 10.1007/s00592-020-01595-5. Epub 2020 Aug 30.
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.
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.
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.
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.
在爱尔兰，糖尿病患者（PwD）对持续皮下胰岛素输注（CSII）的接受程度较低，且存在区域性差异。本研究旨在探讨成年 1 型糖尿病患者获得 CSII 的障碍和促进因素。
采用焦点小组（n=26）和半结构化访谈（n=21）相结合的定性研究方法，对成年 1 型糖尿病患者和医疗保健专业人员（HCP）及其他利益相关者进行研究。使用 NVivo 对数据进行了反思性主题分析。
确定了四个主要主题，包括 CSII 采用的障碍或促进因素：（1）对 CSII 及其益处的认识；（2）糖尿病服务的结构；（3）糖尿病服务提供 CSII 服务的能力；（4）个人态度和个人特征（包括 PwD 和 HCP）的影响。每个主题都与一些类别相关联，其中确定并探讨了 18 个类别。如果卫生服务的结构不足且能力较差（例如，资源不足的诊所），则 CSII 的采用似乎受到个人的兴趣、态度、意愿和动机的影响，这可能会加剧获取 CSII 的区域性不平等。
本研究确定了导致糖尿病护理提供差距的因素，政策制定者可以利用这些因素来改善成年 PwD 获得 CSII 的机会。
