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Who Should Access Closed-Loop Technology? A Qualitative Study of Clinician Attitudes in England.

Accepted version
Peer-reviewed

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Type

Article

Change log

Authors

Murphy, Helen R 

Abstract

Background: Clinicians mediate access to closed-loop technology for people with diabetes. Consequently, their attitudes regarding appropriate levels of closed-loop usage will play a key role in future adoption processes. This study aimed to explore clinician attitudes toward future mainstream closed-loop usage in England. Materials and Methods: We conducted 36 semistructured interviews with clinicians from a range of professional backgrounds working in outpatient clinics in England. Interview topics included clinicians' views on future pathways for closed-loop use and attitudes toward the predictability of users' technology experiences, a key factor in eligibility decision making. We analyzed transcripts using thematic and framework approaches. Results: Clinicians exhibited a range of opinions regarding future eligibility for closed-loop technology. We identified three key strands of clinician opinion, envisaging (1) tighter access for closed loop (n = 10), citing funding challenges and issues arising from user overconfidence or negative technology attitudes; (2) similar access to closed loop as for current diabetes technologies (n = 15), on the grounds that future funding and access pathways will be similar to current arrangements; and (3) wider access for closed-loop technologies (n = 9), given the potential for significant and widespread benefits arising from closed-loop usage, including downstream cost savings alongside improved glycemic control. Conclusions: Clinicians expressed a range of opinions encompassing continuity with current diabetes technologies, while others envisaged either tighter or more liberal access for closed-loop systems. To optimize technology adoption and equitable uptake, future implementation pathways should consider clinician attitudes toward technology use and access.

Description

Keywords

Closed-loop systems, Continuous glucose monitoring, Insulin pumps, Type 1 diabetes, Attitude of Health Personnel, Blood Glucose, Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 1, England, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Qualitative Research

Journal Title

Diabetes Technol Ther

Conference Name

Journal ISSN

1520-9156
1557-8593

Volume Title

22

Publisher

Mary Ann Liebert Inc

Rights

All rights reserved
Sponsorship
Juvenile Diabetes Research Foundation Ltd (JDRF) (2-SRA-2017-359-A-N)
Department of Health (via National Institute for Health Research (NIHR)) (EME 14/23/09)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Helmsley Charitable Trust (#2016PG-T1D045)
Wellcome Trust (100574/Z/12/Z)
European Commission Horizon 2020 (H2020) Societal Challenges (731560)
TCC (None)
NIHR Evaluation Trials and Studies Coordinating Centre (14/23/09)
JDRF