General Practice and Primary Care - Theses
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ItemAssessing and addressing diabetes distress during type 2 diabetes care: Design and implementation of a digital health solution in general practice( 2023-04)Background: Type 2 diabetes (T2D) affects 1.2 million (4.5%) Australians. It is estimated that up to 36% of people with T2D experience diabetes distress, the negative emotional experience resulting from the challenges of living with the demands of diabetes. Diabetes distress impacts diabetes self management and glycaemia. Healthcare professionals can assess diabetes distress using the Problem Areas In Diabetes (PAID) scale. Given that most people with T2D attend general practice, it is important to understand and optimise general practice approaches to assessing and addressing diabetes distress. Aim: This thesis aims to explore current practices for assessing and addressing diabetes distress in Australian general practice and develop an intervention to optimise these. Methods: Following a literature review, I conducted five related studies in two phases aligned with the Knowledge to Action framework. The first phase comprises three studies: a systematic review, interviews with people with T2D, and a survey of general practitioners (GPs). The first study was a systematic review of studies using a Patient Reported Outcome Measure (PROM) to assess depressive symptoms or diabetes distress during T2D care. In study two, I explored people with T2D experiences of emotional support in general practice using qualitative interviews. In study three, an online survey of GPs, I explored the current practices for assessing diabetes distress. In phase two of the thesis, I addressed key gaps identified in phase one in a series of design sessions and a case study to design and implement a digital health solution, PROM-GP. Results: There was a paucity of studies exploring if using the PAID scale during T2D care was associated with improvements in clinical and process outcomes in general practice. People with T2D do not recall completing the PAID scale in consultations with their GP. However, they acknowledged that the GP-patient relationship supported emotional health discussions. People with T2D speculated that the PAID scale would support the discussion if this relationship were absent. Three-quarters of GPs recognise their role in diabetes distress assessment. However, only a quarter GPs routinely ask about or assess for diabetes distress, and only 1.9% use the PAID scale. Health professionals key design preference was supportive language to minimise patients’ negative emotional responses when completing the PAID scale. Implementing PROM-GP was part of an ongoing relationship, with practices inviting people with T2D whom they deemed suitable. COVID-19 impacted healthcare professionals’ capacity to engage with the implementation of PROM-GP. Conclusions: Despite most GPs recognising their role, few routinely ask about or assess diabetes distress. When general practice healthcare professionals use the PAID scale, it is with a limited subset of people with T2D with an existing relationship. This limits the PAID scale use with people without an existing relationship who want to be asked. Healthcare professionals are concerned that asking and completing the PAID scale will elicit a negative emotional, unlike people with T2D who view it as a questionnaire. Competing interests hindered sustained implementation. Future research can focus on systematically implementing the PAID scale with automation during all T2D annual reviews.