More than measurement: practice team experiences of screening for type 2 diabetes.
BACKGROUND
The feasibility, cost-effectiveness and best means to implement population screening for type 2 diabetes remain to be established.


OBJECTIVE
To learn from the experiences of practice staff undertaking a diabetes screening programme in order to inform future screening initiatives.


METHODS
Qualitative analysis of interviews with staff in six general practices in the 'ADDITION-Cambridge' trial; three randomly allocated to intensively manage screen-detected patients and three providing usual care. We conducted semi-structured interviews with seven nurses, four doctors, three health care assistants and four managers. Four researchers analysed the transcripts practice by practice, preparing vignettes and comparing interpretations. Participants commented on a summary report.


RESULTS
Each practice team implemented the screening and intervention programme differently, depending on numbers at risk and decisions about staff contributions. Several emphasized the importance of administrative support. As they screened, they extended the reach of the programme, testing patients outside the target group if requested, checking other risk factors, providing health information and following up people with impaired glucose tolerance. Staff felt that patients accepted the screening and subsequent management as any other clinical activity.


CONCLUSIONS
Although those developing screening programmes attempt to standardize them, primary care teams need to adapt the work to fit local circumstances. Staff need a sense of ownership, training, well-designed information technology systems and protected time. Furthermore, screening is more than measurement; at the individual level, it is a complete health care interaction, requiring individual explanations, advice on health-related behaviour and appropriate follow-up. The UK 'NHS Health Checks' programme should embrace these findings.
Graffy
Jonathan
J
Institute of Public Health, General Practice & Primary Care Research Unit, University of Cambridge, Robinson Way, Cambridge CB2 0SR, UK. jonathan.graffy@phpc.cam.ac.uk
Grant
Julie
J
Williams
Kate
K
Cohn
Simon
S
Macbay
Sara
S
Griffin
Simon
S
Kinmonth
Ann Louise
AL
D000328:Adult; D000368:Aged; D000465:Algorithms; D001291:Attitude of Health Personnel; D001786:Blood Glucose / Q000032:analysis; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000628:therapy; D058006:General Practice; D058005:General Practitioners; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D009726:Nurses / Q000523:psychology; D010820:Physicians / Q000523:psychology; D011364:Professional Practice; D012307:Risk Factors; D006113:United Kingdom
D001786:Blood Glucose
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