ABSTRACT
Introduction: Diabetes clinics have rapidly adopted the use of telemedicine to support ambulatory diabetes care during the COVID-19 pandemic. Objectives: The aim of this study was to explore barriers to and facilitators of the integration of telemedicine in ambulatory diabetes care for adolescents with type 1 diabetes (T1D). Methods: Eight focus groups of parents (n=19) and diabetes care team members (n=18) were conducted in the Seattle, WA metropolitan area. Semi-structured questions were used to elicit views about their experience with telemedicine diabetes clinic visits during the COVID-19 pandemic. Analysis was conducted using an iteratively developed codebook and themes were mapped onto the technology acceptance model (TAM). Results: Barriers (n=5) and facilitators (n=5) were mapped to TAM domains (Table). Facilitators of perceived usefulness and perceived ease of use domains included (1) clinic visit accessibility that aligned with adolescent lifestyle, (2) access to context of daily life at home, and (3) adolescent literacy with videoconferencing technology. Barriers included (1) inability to conduct a physical exam and incorporate findings, (2) inconsistent availability of diabetes technology data, and (3) inability to ensure confidential communication with adolescent. Participant attitudes toward ongoing use of telemedicine were informed by the anticipated level of adolescent engagement in a virtual setting and equity determinants, including the challenges related to attending clinic visits. All participants, especially parents, saw the value in a hybrid model of telemedicine/inperson visits as beneficial for future ambulatory diabetes care. Conclusions: Parents and diabetes care team members report that telemedicine visits are useful and align well with communication and lifestyle needs of adolescents. However, diabetes clinics need to address accessibility issues, improve appointment preparation, and develop techniques for confidential communication. (Table Presented).