Population Screening for Type 1 Diabetes in Pediatrics via Well-Child Visits: Barriers and Facilitators to Implementation.

Abstract

Objective: Screening for type 1 diabetes provides an opportunity to identify those with presymptomatic, early-stage disease, enabling increased monitoring to prevent diabetic ketoacidosis and facilitating access to emerging therapies. Given potential benefits, discussions about population-wide type 1 diabetes screening are ongoing. Routine primary care visits could offer a scalable approach to such screening. We used mixed methods to explore multilevel barriers to and facilitators of type 1 diabetes autoantibody screening at well-child visits and, more broadly, the acceptability, appropriateness, and feasibility of such a screening approach.

Research design and methods: Semi-structured interviews were completed with parents, clinicians, and health insurers. Transcripts were double coded using an iteratively adapted a priori codebook. A survey leveraging the validated Acceptability of Implementation, Intervention Appropriateness, and Feasibility of Intervention Measures instruments was deployed to assess pediatric primary care clinician perspectives.

Results: A total of 26 parents, 10 clinicians (endocrinologists and pediatricians), and two health insurers participated in interviews, and 15 pediatricians participated in the survey. Most parents interviewed and clinicians surveyed found type 1 diabetes screening acceptable and appropriate. Parents noted lack of education, need for a blood draw, costs, difficulty scheduling, and fear of results as barriers. Clinicians reported barriers including parental views on blood draws and clinician time. Insurers described lack of insurance coverage as a barrier. Facilitators across constituents included education, reduced costs, convenient screening, guidelines supporting screening, and institutional support.

Conclusion: If population screening for type 1 diabetes is pursued, models that integrate primary care will be needed. Screening for type 1 diabetes through primary care well-child visits could enable high adoption if implementation strategies adequately address described barriers and promote facilitators.