Visual Abstract
Introduction: Although continuous subcutaneous insulin infusion (CSII) therapy is recognized as effective and safe, its use remains heterogeneous globally and within countries.
The aim of this study was to explore the determinants of uptake and access to CSII for people with type 1 diabetes (PwD) in Ireland.
Methods: A multiphase mixed-methods study was used. Quantitative [secondary data analysis (uptake of CSII), and a national survey of diabetes clinics (availability of CSII)] and qualitative exploration of the barriers and facilitators to accessing CSII by adults [interviews and focus groups] were synthesised using the Pillar Integration Process approach.
Results: Although CSII is fully reimbursed in Ireland, local diversity in uptake and access was observed. Only 6.8% of adult PwD were using CSII in 2016 (range: 2% to 9.6%) and only 47% of clinics offered training to commence CSII. The synthesis of quantitative data and 21 interviews with key stakeholders (health-care professionals - HCP, policy-makers etc.) and 4 focus groups with PwD (n=26) from areas of low, medium and high uptake of CSII resulted in the list of determinants presented in Figure 1.
Conclusion: This study provides evidence on the determinants of access to CSII, can inform policy-makers, health-services planners, HCP and PwD on the complexity of the access to CSII and may help explaining reasons for the variable uptake of CSII uptake worldwide.
K. A. Gajewska: None. R. Biesma: None. K. Bennett: None. S. Sreenan: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk, Other Relationship; Self; Sanofi-Aventis, Speaker’s Bureau; Self; AstraZeneca.
Health Research Board (SPHeRE/2013/1); Diabetes Ireland
