title: Feasibility, acceptability and uptake rates of gestational diabetes mellitus screening in primary care vs secondary care: findings from a randomised controlled mixed methods trial.
abstract: OBJECTIVE
  It is postulated that uptake rates for gestational diabetes mellitus (GDM) screening would be improved if offered in a setting more accessible to the patient. The aim of this study was to evaluate the proportion of uptake of GDM screening in the primary vs secondary care setting, and to qualitatively explore the providers' experiences of primary care screening provision.
  
  
  METHODS
  This mixed methods study was composed of a quantitative unblinded parallel group randomised controlled trial and qualitative interview trial. The primary outcome was the proportion of uptake of screening in both the primary and secondary care settings. All pregnant women aged 18 years or over, with sufficient English and without a diagnosis or diabetes or GDM, who attended for their first antenatal appointment at one of three hospital sites along the Irish Atlantic seaboard were eligible for inclusion in this study. Seven hundred and eighty-one pregnant women were randomised using random permutated blocks to receive a 2 h 75 g OGTT in either a primary (n = 391) or secondary care (n = 390) setting. Semi-structured interviews were conducted with 13 primary care providers. Primary care providers who provided care to the population covered by the three hospital sites involved were eligible for inclusion.
  
  
  RESULTS
  Statistically significant differences were found between the primary care (n = 391) and secondary care (n = 390) arms for uptake (52.7% vs 89.2%, respectively; effect size 36.5 percentage points, 95% CI 30.7, 42.4; p < 0.001), crossover (32.5% vs 2.3%, respectively; p < 0.001) and non-uptake (14.8% vs 8.5%, respectively; p = 0.005). There were no significant differences in uptake based on the presence of a practice nurse or the presence of multiple general practitioners in the primary care setting. There was evidence of significant relationship between probability of uptake of screening and age (p < 0.001). Primary care providers reported difficulties with the conduct of GDM screening, despite recognising that the community was the most appropriate location for screening.
  
  
  CONCLUSIONS
  Currently, provision of GDM screening in primary care in Ireland, despite its acknowledged benefits, is unfeasible due to poor uptake rates, poor rates of primary care provider engagement and primary care provider concerns.
  
  
  BACKGROUND
  http://isrctn.org ISRCTN02232125 FUNDING: This study was funded by the Health Research Board (ICE2011/03).
authors.affiliation: School of Medicine, National University of Ireland, Galway, Ireland. marie.m.tierney@nuigalway.ie.
authors.forename: Marie
authors.initials: M
authors.lastname: Tierney
authors.affiliation: School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Angela
authors.initials: A
authors.lastname: O'Dea
authors.affiliation: J. E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland.
authors.forename: Andriy
authors.initials: A
authors.lastname: Danyliv
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.|Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland.
authors.forename: Liam G
authors.initials: LG
authors.lastname: Glynn
authors.affiliation: Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland.|School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Brian E
authors.initials: BE
authors.lastname: McGuire
authors.affiliation: Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Carmody
authors.affiliation: HRB Clinical Research Facility, National University of Ireland, Galway, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Newell
authors.affiliation: School of Medicine, National University of Ireland, Galway, Ireland.|Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland.
authors.forename: Fidelma P
authors.initials: FP
authors.lastname: Dunne
mesh_terms: D000328:Adult; D016640:Diabetes, Gestational / Q000175:diagnosis*; D005260:Female; D005951:Glucose Tolerance Test; D006297:Health Services Accessibility; D006801:Humans; D007494:Ireland; D008403:Mass Screening; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011320:Primary Health Care; D063127:Secondary Health Care; D055815:Young Adult
keywords: GDM; Gestational diabetes mellitus; Mixed methods; Primary care; Screening; Uptake rates