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Guiding glucose management discussions among adults with type 2 diabetes in general practice: development and pretesting of a clinical decision support tool prototype embedded in an electronic medical record

Kunstler, Breanne E, Furler, John, Holmes-Truscott, Elizabeth, McLachlan, Hamish, Boyle, Douglas, Lo, Sean, Speight, Jane, O'Neal, David, Audehm, Ralph, Kilov, Gary and Manski-Nankervis, Jo-Anne 2020, Guiding glucose management discussions among adults with type 2 diabetes in general practice: development and pretesting of a clinical decision support tool prototype embedded in an electronic medical record, JMIR formative research, vol. 4, no. 9, pp. 1-14, doi: 10.2196/17785.

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Title Guiding glucose management discussions among adults with type 2 diabetes in general practice: development and pretesting of a clinical decision support tool prototype embedded in an electronic medical record
Author(s) Kunstler, Breanne E
Furler, John
Holmes-Truscott, ElizabethORCID iD for Holmes-Truscott, Elizabeth orcid.org/0000-0001-9139-4663
McLachlan, Hamish
Boyle, Douglas
Lo, Sean
Speight, JaneORCID iD for Speight, Jane orcid.org/0000-0002-1204-6896
O'Neal, David
Audehm, Ralph
Kilov, Gary
Manski-Nankervis, Jo-Anne
Journal name JMIR formative research
Volume number 4
Issue number 9
Article ID e17785
Start page 1
End page 14
Total pages 14
Publisher JMIR Publications Inc.
Place of publication Toronto, On.
Publication date 2020
ISSN 2561-326X
2561-326X
Keyword(s) clinical decision support
general practice
primary care
shared decision making
type 2 diabetes
Summary Background Managing type 2 diabetes (T2D) requires progressive lifestyle changes and, sometimes, pharmacological treatment intensification. General practitioners (GPs) are integral to this process but can find pharmacological treatment intensification challenging because of the complexity of continually emerging treatment options. Objective This study aimed to use a co-design method to develop and pretest a clinical decision support (CDS) tool prototype (GlycASSIST) embedded within an electronic medical record, which uses evidence-based guidelines to provide GPs and people with T2D with recommendations for setting glycated hemoglobin (HbA1c) targets and intensifying treatment together in real time in consultations. Methods The literature on T2D-related CDS tools informed the initial GlycASSIST design. A two-part co-design method was then used. Initial feedback was sought via interviews and focus groups with clinicians (4 GPs, 5 endocrinologists, and 3 diabetes educators) and 6 people with T2D. Following refinements, 8 GPs participated in mock consultations in which they had access to GlycASSIST. Six people with T2D viewed a similar mock consultation. Participants provided feedback on the functionality of GlycASSIST and its role in supporting shared decision making (SDM) and treatment intensification. Results Clinicians and people with T2D believed that GlycASSIST could support SDM (although this was not always observed in the mock consultations) and individualized treatment intensification. They recommended that GlycASSIST includes less information while maintaining relevance and credibility and using graphs and colors to enhance visual appeal. Maintaining clinical autonomy was important to GPs, as they wanted the capacity to override GlycASSIST’s recommendations when appropriate. Clinicians requested easier screen navigation and greater prescribing guidance and capabilities. Conclusions GlycASSIST was perceived to achieve its purpose of facilitating treatment intensification and was acceptable to people with T2D and GPs. The GlycASSIST prototype is being refined based on these findings to prepare for quantitative evaluation.
Language eng
DOI 10.2196/17785
Indigenous content off
HERDC Research category C1 Refereed article in a scholarly journal
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30143151

Document type: Journal Article
Collections: Faculty of Health
School of Psychology
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.