Barriers to follow-up for women with a history of gestational diabetes.
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.
Stuebe
Alison
A
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
Ecker
Jeffrey
J
Bates
David W
DW
Zera
Chloe
C
Bentley-Lewis
Rhonda
R
Seely
Ellen
E
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
Diabetes Care. 2003 Jul;26(7):2005-9
12832303
Nat Clin Pract Endocrinol Metab. 2008 Oct;4(10):552-8
18779843
Ann Intern Med. 2006 Oct 3;145(7):488-96
17015866
N Engl J Med. 1961 May 25;264:1082-5
13730123
Obstet Gynecol. 1998 May;91(5 Pt 1):643-7
9572204
Am J Obstet Gynecol. 2004 Oct;191(4):1497-502
15507990
Diabetes Care. 1997 Apr;20(4):537-44
9096977
N Engl J Med. 2002 Feb 7;346(6):393-403
11832527
Am J Obstet Gynecol. 2008 Apr;198(4):404.e1-6
18241820
J Am Med Inform Assoc. 2009 Jul-Aug;16(4):465-70
19390104
N Engl J Med. 2008 Jul 3;359(1):50-60
18565855
Am J Obstet Gynecol. 1982 Dec 1;144(7):768-73
7148898
Obstet Gynecol. 2008 Oct;112(4):868-74
18827130
Obstet Gynecol. 1999 May;93(5 Pt 1):734-7
10912976
Lancet. 2002 Jun 15;359(9323):2072-7
12086760
Am J Obstet Gynecol. 2008 May;198(5):528.e1-5
18191799
Diabetes Care. 2002 Oct;25(10):1862-8
12351492
Obstet Gynecol. 2006 Oct;108(4):961-8
17012460
Obstet Gynecol. 2009 Jun;113(6):1419-1421
19461459
JAMA. 1999 Oct 20;282(15):1458-65
10535437
J Am Med Inform Assoc. 2005 Jul-Aug;12(4):431-7
15802479
Obstet Gynecol. 2004 Jun;103(6):1229-34
15172857
N Engl J Med. 2001 May 3;344(18):1343-50
11333990
Obstet Gynecol. 2005 Dec;106(6):1297-303
16319255
Am J Public Health. 2006 Sep;96(9):1643-8
16873752