Developing a successful implementation plan for a high frequency, low touch care model at specialized type 1 diabetes clinics: The Type 1 diabetes virtual self-Management and Education support (T1ME) trial (Preprint)

BACKGROUND Individuals with type 1 diabetes (T1D) are more likely to achieve optimal glycemic control when they have frequent visits with their healthcare team. There is a potential benefit of frequent, telemedicine interventions as an effective strategy to lower hemoglobin A1c (HbA1c). OBJECTIVE To understand the provider- and system-level factors affecting successful implementation of a virtual care intervention into type 1 diabetes (T1D) clinics. METHODS Semi-structured interviews with managers and certified diabetes educators (CDEs) at diabetes clinics across Southern Ontario, prior to the COVID-19 pandemic. Deductive analysis using the Theoretical Domains Framework, then mapping to Behaviour Change Techniques to inform potential implementation strategies for high frequency virtual care for T1D. RESULTS There was considerable intention to deliver high frequency virtual care to patients with T1D. Participants believed that this model of care could lead to improved patient outcomes and engagement, but would likely increase the workload of CDEs. Some felt there were insufficient resources at their site to enable them to participate in the program. Member-checking conducted during the pandemic revealed that clinics and staff had already developed strategies to overcome resource barriers to the adoption of virtual care during the pandemic. CONCLUSIONS Existing enablers for high frequency virtual care can be leveraged, and barriers can be overcome with targeted clinical incentives and support.