title: Barriers to follow-up for women with a history of gestational diabetes.
abstract: Women with gestational diabetes (GDM) are at increased risk for type 2 diabetes (T2DM), but many do not receive recommended follow-up. We sought to identify barriers to follow-up screening. We surveyed primary care providers (PCPs) and obstetric and gynecology care providers (OBCPs) in a large health system. We also assessed documentation of GDM history in the health care system's electronic medical record. Four hundred seventy-eight clinicians were surveyed, among whom 207 responded. Most participants (81.1%) gave an accurate estimate of risk of progression to T2DM. PCPs were less likely than OBCPs to ask patients about history of GDM (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.20 to 0.90), but they were far more likely to indicate that they order glucose screening for women with a known history (OR 4.31, 95% CI 2.01 to 9.26). Providers identified poor communication between OBCPs and PCPs as a major barrier to screening. Fewer than half (45.8%) of 450 women with GDM by glucose tolerance test criteria had that history documented on their electronic problem list. Clinicians are aware that women with GDM are at high risk of developing type 2 diabetes, but they do not routinely assess and screen patients, and communication between OBCPs and PCPs can be improved.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599, USA. astuebe@med.unc.edu
authors.forename: Alison
authors.initials: A
authors.lastname: Stuebe
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ecker
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.forename: Chloe
authors.initials: C
authors.lastname: Zera
authors.forename: Rhonda
authors.initials: R
authors.lastname: Bentley-Lewis
authors.forename: Ellen
authors.initials: E
authors.lastname: Seely
mesh_terms: D002983:Clinical Competence / Q000592:standards; D003266:Continuity of Patient Care / Q000458:organization & administration; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000503:physiopathology; D057286:Electronic Health Records; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration; D011247:Pregnancy; D011320:Primary Health Care / Q000458:organization & administration; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
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