title: Understanding type 2 diabetes mellitus screening practices among primary care physicians: a qualitative chart-stimulated recall study.
abstract: Early diagnosis and treatment of prediabetes and type 2 diabetes mellitus (T2DM) can prevent future health problems, yet many individuals with these conditions are undiagnosed. This could be due, in part, to primary care physicians' (PCP) screening practices, about which little is known. The objectives of this study were to identify factors that influence PCPs' decisions to screen patients for T2DM and to characterize their interpretation and communication of screening test results to patients.
  
  
  
  We conducted semi-structured chart-stimulated recall interviews with 20 University of Michigan Health System (UMHS) primary care physicians. PCPs were asked about their recent decisions to screen or not screen 134 purposively sampled non-diabetic patients who met American Diabetes Association criteria for screening for T2DM. Interviews were audio-recorded, transcribed, and analyzed using qualitative directed content analysis. Data on patient demographic characteristics and comorbidities were abstracted from the electronic health record.
  
  
  
  The most common reasons PCPs gave for not screening 63 patients for T2DM were knowledge of a previously normal screening test (49%) and a visit for reasons other than a health maintenance examination (48%). The most common reasons PCPs gave for screening 71 patients for T2DM were knowledge of a previously abnormal screening test (49%), and patients' weight (42%) and age (38%). PCPs correctly interpreted 89% of screening test results and communicated 95% of test results to patients. Among 24 patients found to have prediabetes, PCPs usually (58%) recommended weight loss and increased physical activity but never recommended participation in a Diabetes Prevention Program or use of metformin.
  
  
  
  Previous screening test results, visit types, and patients' weight and age influenced PCPs' decisions to screen for T2DM. When patients were screened, test results were generally correctly interpreted and consistently communicated. Recommendations to patients with prediabetes could better reflect evidence-based strategies to prevent T2DM.
authors.affiliation: VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 14, Room G100-36, Ann Arbor, MI, 48109-2800, USA. dhafez@med.umich.edu.|Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI, USA. dhafez@med.umich.edu.|University of Michigan Medical School, Ann Arbor, MI, USA. dhafez@med.umich.edu.|University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA. dhafez@med.umich.edu.
authors.forename: Dina
authors.identifier: 0000-0002-2260-0299
authors.initials: D
authors.lastname: Hafez
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Nelson
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Evan G
authors.initials: EG
authors.lastname: Martin
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI, USA.|University of Michigan Medical School, Ann Arbor, MI, USA.|University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Cohen
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Northway
authors.affiliation: VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 14, Room G100-36, Ann Arbor, MI, 48109-2800, USA.|University of Michigan Medical School, Ann Arbor, MI, USA.|University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Kullgren
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy; D042241:Early Diagnosis; D061345:Early Medical Intervention; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007388:Internal Medicine; D008297:Male; D008403:Mass Screening; D011939:Mental Recall; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D010821:Physicians, Family; D058007:Physicians, Primary Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011236:Prediabetic State / Q000175:diagnosis* / Q000628:therapy; D036301:Qualitative Research; D040242:Risk Reduction Behavior
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
keywords: Communication; Diabetes prevention; Prediabetes; Preventive care; Primary care; Type 2 diabetes mellitus; lifestyle counseling