Kathryn A Paez1, Emma M Eggleston2, Susan J Griffey3, Brandy Farrar4, Jacquelyn Smith3, Jennifer Thompson2, Matthew W Gillman2. 1. Health Policy and Research, Health and Social Development, American Institutes for Research, Silver Spring, Maryland. Electronic address: kpaez@air.org. 2. Obesity Prevention Program, Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts. 3. Social & Scientific Systems, Inc., Silver Spring, Maryland. 4. Health Policy and Research, Health and Social Development, American Institutes for Research, Silver Spring, Maryland.
Abstract
BACKGROUND: The proportion of women with previous gestational diabetes mellitus (GDM) receiving postpartum diabetes testing is far less than desired. Even in health care systems with high testing rates, some women remain untested. We explored what helps and what hinders women to obtain recommended testing. METHODS: In this mixed methods study, we recruited 139 patients with a history of GDM in their most recent pregnancy (6 months to 4.5 years before study enrollment) from a delivery system that had instituted a quality improvement program to increase postpartum diabetes testing rates. We determined whether they had received a postpartum diabetes test according to American Diabetes Association guidelines. Using survey data, we ran logistic regression models to assess correlates of testing status, and we conducted in-depth interviews with 22 women to provide greater context to their survey responses. RESULTS: Of the 139 women, 21 women (15%) did not complete recommended diabetes testing. From the survey data, women who visited a primary care provider had 72% (95% CI, 0.09-0.83) lesser odds of not having been tested. From the qualitative interviews, difficulty fitting testing around work and caregiver demands were the most common reasons for not testing. Untested women interpreted providers' reassurances that diabetes would resolve after delivery and lack of reminders to reschedule missed appointments and to complete diabetes testing as indicators that their physicians were not concerned about their diabetes risk. CONCLUSIONS: Among hard-to-reach women, multiple demands on their time were common explanations for not receiving a postpartum diabetes test. Consistent messages regarding long-term diabetes risk during pregnancy, access to postpartum primary care and convenient lab appointments, and systematic reminders to providers and patients are approaches that, in combination, may influence more resistant women to test.
BACKGROUND: The proportion of women with previous gestational diabetes mellitus (GDM) receiving postpartum diabetes testing is far less than desired. Even in health care systems with high testing rates, some women remain untested. We explored what helps and what hinders women to obtain recommended testing. METHODS: In this mixed methods study, we recruited 139 patients with a history of GDM in their most recent pregnancy (6 months to 4.5 years before study enrollment) from a delivery system that had instituted a quality improvement program to increase postpartum diabetes testing rates. We determined whether they had received a postpartum diabetes test according to American Diabetes Association guidelines. Using survey data, we ran logistic regression models to assess correlates of testing status, and we conducted in-depth interviews with 22 women to provide greater context to their survey responses. RESULTS: Of the 139 women, 21 women (15%) did not complete recommended diabetes testing. From the survey data, women who visited a primary care provider had 72% (95% CI, 0.09-0.83) lesser odds of not having been tested. From the qualitative interviews, difficulty fitting testing around work and caregiver demands were the most common reasons for not testing. Untested women interpreted providers' reassurances that diabetes would resolve after delivery and lack of reminders to reschedule missed appointments and to complete diabetes testing as indicators that their physicians were not concerned about their diabetes risk. CONCLUSIONS: Among hard-to-reach women, multiple demands on their time were common explanations for not receiving a postpartum diabetes test. Consistent messages regarding long-term diabetes risk during pregnancy, access to postpartum primary care and convenient lab appointments, and systematic reminders to providers and patients are approaches that, in combination, may influence more resistant women to test.
Authors: Hannah R Lucas; Roxann C Williams; Laura N Hollar; Bethany Johnson-Javois; Heidi B Miller; Amanda Stoermer; Graham A Colditz; Aimee S James; Cynthia J Herrick Journal: Clin Diabetes Date: 2022-01
Authors: Susan D Brown; Monique M Hedderson; Yeyi Zhu; Ai-Lin Tsai; Juanran Feng; Charles P Quesenberry; Assiamira Ferrara Journal: BMJ Open Diabetes Res Care Date: 2022-06
Authors: Amanda Vu; Norman Turk; O Kenrik Duru; Carol M Mangione; Hemali Panchal; Sarah Amaya; Yelba Castellon-Lopez; Keith Norris; Tannaz Moin Journal: Diabetes Spectr Date: 2022-03-23
Authors: Barbara Daly; Konstantinos A Toulis; Neil Thomas; Krishna Gokhale; James Martin; Jonathan Webber; Deepi Keerthy; Kate Jolly; Ponnusamy Saravanan; Krishnarajah Nirantharakumar Journal: PLoS Med Date: 2018-01-16 Impact factor: 11.069