(DCP057) PEDIATRIC DIABETES: AN EXPLORATION OF SHARED CARE IN NOVA SCOTIA

Background: Care for pediatric type 1 diabetes(T1D) in Nova Scotia(NS) occurs at one tertiary care pediatric centre in Halifax (central zone) and several regional diabetes centres(DC) across the province serving all ages. Ideally, children receive diabetes care close to home to minimize the burden of disease experience, however, the increasing complexity of diabetes care means shared care between tertiary and regional centres is often sought by families and/or practitioners. We aimed to assess patterns in the provision of pediatric T1D care throughout NS and to understand the perspectives of DC staff.

METHODS AND RESULTS: The Diabetes Care Program of NS (DCPNS) registry contains records for all DC visits in NS. Patients living outside of the central zone at diagnosis, aged < 15 years with T1D diagnosed between 2007-2016 and 2+ years of follow-up were classified as receiving shared, tertiary-only, or regional-only care. Shared care was defined as having regular or intermittent visits at both the tertiary and a regional DC. Semi-structured qualitative interviews were conducted with 20 staff and physicians working in regional and tertiary DCs to understand facilitators and challenges in shared care. Interviews were transcribed, coded, and analyzed for themes using NVivo.

Of 267 patients living outside central zone, 20% received tertiary care only, 37% regional only, 31% received ongoing shared care with rates varying by region, and 12% saw the tertiary centre only at the time of initial diagnosis. Children < 5 years old were more likely to have some shared care compared to older children. Two overarching themes from interviews were: Communication and Resources. Communication concerns revolved around variable formats and patterns of communication between regional and tertiary DCs as well as intra-centre communication between physicians and diabetes educators. Resource needs included mental health/social work support, after-hours phone support for families, and dedicated time for continuing professional development in pediatrics.

Conclusion: Four in 10 patients living in predominantly rural NS received some degree of shared care. Shared care represents a significant portion of pediatric diabetes care in NS but there is a need for formalized shared care processes. Existing networks such as the DCPNS registry could be leveraged to enhance standardized information collection and sharing across providers. Provincial support for regional DCs is needed to facilitate both continuing professional development and province-wide psychosocial supports with equitable access, enhancements would benefit all patients.