Health service leaders’ perspectives on Type 1 diabetes models of care for children and young adults in Australia: a mixed-methods study

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.