Asking The Right Questions: Co-designing a pre-consultation assessment tool to meet the needs of people with diabetes in Western Sydney

Background: Type 2 diabetes (T2D) continues to be the leading burden of disease globally. With the growing population of people with diabetes, it is essential to deliver integrated care that is value-based and patient-centred, as well as high-value to providers and the healthcare system. Community-facing digital interventions have transformed the care delivered to these patients. However, few have been co-designed to specifically address patient needs. Western Sydney Diabetes (WSD) has developed a pre-consultation assessment tool to allow the specialist team to capture patient information to prepare for consultations and facilitate better diabetes care plans. The long-term goal is for the tool to be used for providing personalised care to meet individual patient needs and priorities. Aim: This study aims to: (1) co-design a pre-appointment priority setting tool with patients and health care professionals (2) evaluate the feasibility and acceptability of the prototype. Methods: A co-design process was conducted using qualitative methods: (1) 3 focus groups with patients, consumer representatives and diabetes health professionals to identify key needs and concerns; and (2) Individual think aloud end-user testing interviews to understand and improve the acceptability of the tool. Data were analysed in stages to assess the acceptability of the tool and make iterative improvements to better identify and address patient needs and priorities Results: Data from focus groups (n=11) suggested the tool could be improved by changing the order to prioritise the most important questions, shortening the tool to make it less time consuming and a non-overwhelming format. Participants highlighted the benefits of completing the tool seeking necessary information for management of their diabetes, and the importance of including questions for diabetes complications, in particular mental health, to support holistic care. Co-design methods assisted in identifying and balancing the needs of both patients and providers, as patients highlighted the tool to be simple and easy whilst providers needed to capture as much information possible. Delivering the tool in multiple formats, including online and paper-based formats, might increase uptake. The findings were used to redevelop the tool in a new integrated care platform, a patient care portal providing diabetes education content shared between General Practices and specialist teams in Western Sydney. Discussion: The Co-design process led to more acceptable content that met two different user groups and informed the roll-out of a new digital format. This tool will be used to inform pre-clinic processes and discussions by multi-disciplinary health care teams, to facilitate a tailored patient-centred approach in delivery of Integrated care. Further research is needed to test the impact of the refined tool on diabetes management and quality of care.