The influence of process, structure and policy on Haemoglobin A1c levels in treatment of children and adolescents with type 1 diabetes
2012 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 96, no 3, 331-338 p.Article in journal (Refereed) Published
Objective: We aimed to identify factors for improvements of mean A1C at centres treating children and adolescents with diabetes.
research Design and methods: Through data from the Swedish paediatric diabetes quality registry, SWEDIABKIDS, five centres with the lowest mean A1C (Low group), five with the highest (High group), and five with the largest decrease in centre mean A1C (Decrease group) were identified. The diabetes team members completed a questionnaire, response rate 85%, (109/128) and reported team structure and process. Open-ended questions regarding messages to patients about important diabetes matters were analysed with summative content analysis.
Results: Compared to the High group, the Low and Decrease groups showed shorter professional experience and lower proportion of special diabetes-educated team members, and higher compliance with guidelines. Trends for higher mean insulin dose, larger centre size and larger team size were found. The content analysis indicated that the Low and Decrease groups gave a clear message and had lower A1C target value. The team members in these groups were engaged, had a positive attitude and a perception of a well-functioning team. The High group gave a vague message, needed more frames and had a perception of lack of cooperation in the team.
Conclusions: The team members' approach seems to affect metabolic control in children and adolescents. The team members need to be aware of their approach and how it affects patients and parents, and also of the importance of the possibility of using resources and competence within the team.
Place, publisher, year, edition, pages
2012. Vol. 96, no 3, 331-338 p.
Type 1 diabetes, pediatric, centre difference, HbA1c, summative content analysis
IdentifiersURN: urn:nbn:se:liu:diva-59312DOI: 10.1016/j.diabres.2012.01.016ISI: 000305281100021OAI: oai:DiVA.org:liu-59312DiVA: diva2:351138