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INEQUALITIES AND HETEROGENEITY IN ACCESSING DIABETES-RELATED TECHNOLOGY: DETERMINANTS OF UPTAKE AND ACCESS TO INSULIN PUMP THERAPY BY ADULTS WITH TYPE 1 DIABETES IN IRELAND
Abstract
Background and Aims
Although continuous subcutaneous insulin infusion (CSII) therapy is recognized as effective and safe, its use remains heterogeneous globally and within countries. This study aimed to explore the determinants of uptake and access to insulin pump therapy by people with type 1 diabetes (PwD) in Ireland.
Methods
A multiphase mixed-methods research design was used. Quantitative (i) evidence on uptake of CSII (secondary data analysis of pharmacy claims data) and on availability of CSII (national survey of diabetes clinics), and qualitative (ii) exploration of the barriers and facilitators in accessing CSII [interviews with key stakeholders (health-care professionals-HCP, policy-makers etc.) and focus groups with PwD (from areas of low, medium and high uptake of CSII)] were synthesised using the Pillar Integration Process approach.
Results
In Ireland: 6.8% of adults with type 1 diabetes were using CSII in 2016 (range: 2% to 9.6%); one-third of diabetes clinics did not offer any type of CSII services; and less than half of clinics offered training to commence CSII. The synthesis of all findings (including qualitative: 21 interviews and 4 focus groups) provided the list of determinants: funding/reimbursement; dwelling location/availability in local clinics; structure of the health-service; capacity (resources/expertise); awareness/education; and impact of individual factors (PwD and HCP attitudes).
Conclusions
Despite the full reimbursement, local diversity in uptake and access to CSII was observed in Ireland. The results of this study can inform policy-makers, health-services planners, HCP and PwD on the complexity of the access to CSII and may help explain reasons for the variable uptake of CSII uptake worldwide.