Implementing the Digital Diabetes Questionnaire as a Clinical Tool in Routine Diabetes Care: Focus Group Discussions With Patients and Health Care Professionals

Abstract

Background The Diabetes Questionnaire is a digital patient-reported outcome and experience measure for adults living with diabetes. The Diabetes Questionnaire is intended for use in routine clinical visits in diabetes care and to enable patient perspectives to be integrated into the Swedish National Diabetes Register. The Diabetes Questionnaire was developed on the basis of patients’ perspectives, and evidence for its measurement qualities has been demonstrated. Patients receive an invitation to complete the questionnaire before clinical visits, and the patient and health care professional (HCP) can discuss the findings, which are instantly displayed during the visit. Implementation processes for new tools in routine care need to be studied to understand the influence of contextual factors, the support needed, and how patients and HCPs experience clinical use. Objective The aim of this study was to describe patients’ and HCPs’ experiences of initiating the use of the digital Diabetes Questionnaire as a clinical tool in routine diabetes care, supported by a structured implementation strategy involving initial education, local facilitators, and regular follow-ups. Methods In this qualitative study, semistructured focus group discussions were conducted 12 months after the use of the Diabetes Questionnaire was initiated. Participants were diabetes specialist nurses and physicians (20 participants in 4 groups) at hospital-based outpatient clinics or primary health care clinics and adults with type 1 or type 2 diabetes (15 participants in 4 groups). The audiotaped transcripts were analyzed using inductive qualitative content analysis. Results The results revealed 2 main categories that integrated patients’ and HCPs’ experiences, which together formed an overarching theme: While implementation demands new approaches, the Diabetes Questionnaire provides a broader perspective. The first main category (The Diabetes Questionnaire supports person-centered clinical visits) comprised comments expressing that the digital Diabetes Questionnaire can initiate and encourage reflection in preparation for clinical visits, bring important topics to light during clinical visits, and broaden the scope of discussion by providing additional information. The second main category (The process of initiating the implementation of the Diabetes Questionnaire) comprised comments that described differences in engagement among HCPs and their managers, challenges of establishing new routines, experiences of support during implementation, thoughts about the Diabetes Questionnaire, need to change local administrative routines, and opportunities and concerns for continued use. Conclusions The Diabetes Questionnaire can broaden the scope of health data in routine diabetes care. While implementation demands new approaches, patients and HCPs saw potential positive impacts of using the questionnaire at both the individual and group levels. Our results can inform further development of implementation strategies to support the clinical use of the questionnaire.

Standardising personalised diabetes care across European health settings: A person‐centred outcome set agreed in a multinational Delphi study

“…In this way, implementing the outcome set can support person-centred communication during consultations as well as precision monitoring, enabling better informed treatment decisions and holistic diabetes care. 6,7,24 By providing precise definitions of community-relevant outcomes, the outcome set offers a framework for large-scale data comparability and enables the alignment of generic PROs between different conditions, both promoting implementation and contributing to high-quality and scalable outcome assessment. 25,26 In this way, data from routine care can inform assessments of effectiveness and quality of care and identify population-level needs, potentially substituting observational studies and contributing to diabetes research and health policy.…”

“…Long-term data on the acceptability of using PROs in clinical diabetes consultations are scarce. 6,7,15,28 For this reason, we are currently preparing a feasibility study under the H2O project aiming to identify aspects that require refinement. At the same time, we are exploring different alternatives to assessing T A B L E 4 Clinical and person-reported outcomes (domains) of the final diabetes outcome set.…”

“…When actively using PROM results in consultations, healthcare providers can dedicate time to and specifically ask about identified concerns, while answering PROMs can help people with diabetes to self‐reflect and identify priority issues they wish to discuss. Both can foster more meaningful conversations at eye‐level 6,7 . This may also support effective time and resource allocation 5,8 …”

“…Both can foster more meaningful conversations at eye-level. 6,7 This may also support effective time and resource allocation. 5,8 Efforts have been made to standardise this approach by defining diabetes outcome sets that combine clinical outcomes and PROs to allow for comparison of holistic health data over time and across individuals.…”

“…The objective was to propose a standard for collecting key diabetes outcomes in routine care that can be of value for different stakeholders, benefitting diabetes care at multiple levels and thus be adopted in a more sustainable way. While its use in individual practice can support person‐centred communication and individualised treatment decisions, 6,7 it can simultaneously generate data that is comparable across individuals, enabling mutual learning between healthcare providers as well as research with real‐world data, including assessment of effectiveness and quality of care and new risk stratifications 17 . Furthermore, such data can be used to identify population health needs and inform public health decisions 18 .…”