title: Supporting patients with type 1 diabetes using continuous subcutaneous insulin infusion therapy: Difficulties, disconnections, and disarray.
abstract: OBJECTIVE
  Use of continuous subcutaneous insulin infusion therapy in type 1 diabetes management is high. However, the incorporation of this technology into self-care is not without challenges, and the support of an appropriately skilled health care team is recommended. This study aimed to examine the support context for patients using continuous subcutaneous insulin infusion therapy from the health care professional perspective, as well as contextual influences for health care professionals and their patients.
  
  
  METHODS
  This ethnographic qualitative study was undertaken in New South Wales, Australia. Recruitment occurred using a snowball sampling technique, beginning with members of an established diabetes service group. Data were collected through the use of semistructured interviews undertaken by telephone and analysed using thematic analysis.
  
  
  RESULTS
  Data were obtained from 26 interviews with staff from diverse professional backgrounds. An overarching theme of difficulties, disconnections, and disarray emerged, with findings indicating that participants perceived difficulties in relation to shortages of health care professional continuous subcutaneous insulin infusion-related expertise, and disconnected and disarrayed service structures and process, with barriers to access to these devices. Individual health care professionals were left to manage somehow or opted not to engage with related care.
  
  
  CONCLUSIONS
  Findings provide insights from health care professionals' perspectives into the complexity of providing support for patients using continuous subcutaneous insulin infusion therapy across diverse contexts, and provide a platform for further research and service development. The need for consistent and coordinated care, and the infrastructure to facilitate this, flags an opportunity to drive integration of care and teamworking across as well as within settings and disciplines.
authors.affiliation: Faculty of Health, University of Technology Sydney/South Eastern Sydney Local Health District, Prince of Wales Hospital, Randwick, Australia.
authors.forename: Lin
authors.initials: L
authors.lastname: Perry
authors.affiliation: Faculty of Health, University of Technology Sydney, Ultimo, Australia.
authors.forename: Steven
authors.identifier: http://orcid.org/0000-0002-3928-9206
authors.initials: S
authors.lastname: James
authors.affiliation: Charles Perkins Centre, University of Sydney, Sydney, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Gallagher
authors.affiliation: Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.
authors.forename: Janet
authors.initials: J
authors.lastname: Dunbabin
authors.affiliation: Sydney Medical School, University of Sydney/Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, Australia.
authors.forename: Katharine
authors.initials: K
authors.lastname: Steinbeck
authors.affiliation: Department of Medicine, University of Toronto/Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Lowe
mesh_terms: D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004867:Equipment Design; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000706:statistics & numerical data*; D009517:New South Wales; D010348:Patient Care Team / Q000458:organization & administration*; D010353:Patient Education as Topic; D036301:Qualitative Research; D012648:Self Care / Q000379:methods*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: delivery of health care; diabetes mellitus type 1; insulin infusion systems; patient care