Engaging GPs in insulin therapy initiation : a qualitative study evaluating a support program in the Belgian context

Background: A program supporting the initiation of insulin therapy in primary care was introduced in Belgium, as part of a larger quality improvement project on diabetes care. This paper reports on a study exploring factors influencing the engagement of general practitioners (GPs) in insulin therapy initiation (research question 1) and exploring factors relevant for future program development (research question 2). Methods: We have used semi-structured interviews to answer the first research question: two focus group interviews with GPs who had at least one patient in the insulin initiation program and 20 one-to-one interviews with GPs who were not regular users of the overall support program in the region. To explore factors relevant for future program development, the data from the GPs were triangulated with data obtained from individual interviews with patients (n=10), the diabetes nurse educator (DNE) and the specialist involved in the program, and data extracted from meeting reports evaluating the insulin initiation support program. Results: We found differences between GPs engaged and those not engaged in insulin initiation in attitude, subjective norm and perceived behavioural control regarding insulin initiation. In general the support program was evaluated in a positive way by users of the program. Some aspects need further consideration: job boundaries between the DNE and GPs, job boundaries between GPs and specialists, protocol adherence and limited case load. Conclusion: The study shows that the transition of insulin initiation from secondary care to the primary care setting is a challenge. Although a support program addressing known barriers to insulin initiation was provided, a substantial number of GPs were reluctant to engage in this aspect of care. Important issues for future program development are: an interdisciplinary approach to job clarification, a dynamic approach to the integration of expertise in primary care and feedback on protocol adherence. Trial registration: ClinicalTrials.gov Identifier:NCT0082449

Acute Hepatitis of Unknown Aetiology Among Young Children: Research Agenda by the ESPGHAN Hepatology Committee

In April 2022, an increased incidence of acute hepatitis cases of unknown aetiology among previously healthy children across the United Kingdom was described. Since, more than 200 cases from United Kingdom and hundreds more from all across the world have been reported. The majority of affected children were younger than six years of age. The clinical presentation was nonspecific with diarrhoea and vomiting usually preceding the appearance of jaundice, abdominal pain, nausea and malaise. Approximately 10% have required liver transplantation. An infectious aetiology has been considered likely given the epidemiological and clinical features of the reported cases. More than 60% of the children tested were diagnosed with adenovirus infection although a clear aetiological connection has still to be demonstrated. No link with SARS-CoV-2 infection and COVID-19 vaccine was found. What is not clear to date is whether the high number of acute hepatitis cases reported is related to a true increase in incidence or heightened awareness following on from the initial reports from the United Kingdom. The Hepatology Committee of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition developed a paper on the current outbreak of acute hepatitis of unknown aetiology recognizing its importance and the need of approaching the current situation with a scientifically rigorous approach. The aims of the paper are to summarize the current knowledge and to identify the most pertinent issues regarding the diagnosis and management of this condition and the research questions raised