A physician reminder to improve postpartum diabetes screening in women with gestational diabetes mellitus

Lega, Iliana C.; McLaughlin, Heather; Coroneos, Marie K.; Handley-Derry, Frances; Donovan, Nicola; Lipscombe, Lorraine L.

doi:10.1016/j.diabres.2011.10.023

Cited by 34 publications

(40 citation statements)

References 18 publications

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“…Even during the short period of this study, local guidelines changed three times [25][26][27], with some variation from national guidelines [28], and have subsequently been revised twice [76], broadly in line with revised national guidelines [37]. Recent studies show that comparatively simple 'interventions' can improve postpartum glucose screening rates [77], including physician reminders [78], system changes [31,73,79], proactive postpartum care plans [80], antenatal education [81], registers [82], clinical protocols, electronic records and patient reminders [83]. One study in the United States showed stark comparisons between high rates of early postpartum Papanicolaou (Pap) testing for cervical cancer (94 %), and concurrent low rates of postpartum glucose screening among women with GDM (37 %) [84].…”

Section: Discussionmentioning

confidence: 98%

Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes

Chamberlain

McLean

Oats

et al. 2014

Matern Child Health J

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Women with gestational diabetes have a high risk of type 2 diabetes postpartum, with Indigenous women particularly affected. This study reports postpartum diabetes screening rates among Indigenous and non-Indigenous women with gestational diabetes, in Far North Queensland, Australia. Retrospective study including 1,012 women with gestational diabetes giving birth at a regional hospital from 1/1/2004 to 31/12/2010. Data were linked between hospital records, midwives perinatal data, and laboratory results, then analysed using survival analysis and logistic regression. Indigenous women had significantly longer times to first oral glucose tolerance test (OGTT) [hazards ratio (HR) 0.62, 95 % confidence interval (CI) 0.48-0.79, p < 0.0001) and 'any' postpartum glucose test (HR 0.81, 95 % CI 0.67-0.98, p = 0.03], compared to non-Indigenous women. Postpartum screening rates among all women were low. However, early OGTT screening rates (<6 months) were significantly lower among Indigenous women (13.6 vs. 28.3 %, p < 0.0001), leading to a persistent gap in cumulative postpartum screening rates. By 3 years postpartum, cumulative rates of receiving an OGTT, were 24.6 % (95 % CI 19.9-30.2 %) and 34.1 % (95 % CI 30.6-38.0 %) among Indigenous and non-Indigenous women, respectively. Excluding OGTTs in previous periods, few women received OGTTs at 6-24 months (7.8 vs. 6.7 %) or 2-4 years (5.2 vs. 6.5 %), among Indigenous and non-Indigenous women, respectively. Low rates of postpartum diabetes screening demonstrate that essential 'ongoing management' and 'equity' criteria for population-based screening for gestational diabetes are not being met; particularly among Indigenous women, for whom recent guideline changes have specific implications. Strategies to improve postpartum screening after gestational diabetes are urgently needed.

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Section: Discussionmentioning

confidence: 98%

Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes

Chamberlain

McLean

Oats

et al. 2014

Matern Child Health J

View full text Add to dashboard Cite

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“…[5][6][7][8][9] By informing about our background when we introduced ourselves to the interviewees we are aware that we may have created a distance to the context in sense of our role in the healthcare system. This may have been a barrier in the interview possibly causing the women to be more aware of their statements, which could have affected their openness.…”

Section: Awareness Of Limitationsmentioning

confidence: 99%

“…4 In other contexts follow-up screening is handled by obstetricians. 6 This study was undertaken to improve our understanding of how women with gestational diabetes experience the treatment and care offered by a regional health service in Denmark, including obstetricians, midwives and nurses in the secondary health sector and general practitioners in the primary health sector. We also sought to understand how the women's experiences influenced their subsequent participation in follow-up screening.…”

mentioning

confidence: 99%

“…Lacking continuity and poor coordination of care among health providers have been suggested as key obstacles to effective communication concerning the importance of follow-up screening. 6,[9][10][11] The patients' involvement in and eventual compliance with treatment is jeopardised by low levels of information in combination with errors and a lack of patient-centeredness, 12,13 which may adversely affect participation in follow-up screening and women's experiences of treatment and care. Despite the free access to public health services in Denmark participation in follow-up screening remains low.…”

mentioning

confidence: 99%

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Reasons for women's non-participation in follow-up screening after gestational diabetes

Nielsen¹,

Olesen

Kristiansen

et al. 2015

Women and Birth

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“…7,8 Several studies to date have shown that use of an automatic reminder system improves postpartum diabetes screening rates. [9][10][11][12][13][14][15] Identification of clinical predictors of diabetes testing is required to target high risk populations, create effective models of patient care postpartum and develop interventional strategies. We designed this study to address two important clinical questions: (1) do maternal characteristics, obstetrical factors, GDM care delivery or utilization of health services postpartum predict if a woman with GDM will complete a screening test in the first year postpartum?…”

Section: Introductionmentioning

confidence: 99%

Clinical predictors for diabetes screening in the first year postpartum after gestational diabetes

et al. 2014

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Background: Postpartum screening for diabetes in women with gestational diabetes (GDM) improves with use of reminder systems. Our primary objective was to identify predictors of diabetes screening in the first year after delivery. Methods: A retrospective study was performed of 556 women with GDM who received outpatient prenatal care between 2007 and 2009. A mailed reminder system was utilized at two sites. Rates of postpartum glucose testing at 6 and 12 months postpartum were measured. Results: Site of care and non-smoking status were identified as the only predictors of postpartum diabetes screening (p50.001 and p ¼ 0.02, respectively). Rates of OGTT completion at one year (38% vs. 19% p50.001) were higher in women who attended clinics with postpartum reminders. Conclusions: The site of diabetes care in pregnancy is a major predictor of adherence to diabetes screening postpartum. Health care delivery should be considered in the development of strategies to increase screening rates.

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A physician reminder to improve postpartum diabetes screening in women with gestational diabetes mellitus

Cited by 34 publications

References 18 publications

Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes

Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes

Reasons for women's non-participation in follow-up screening after gestational diabetes

Clinical predictors for diabetes screening in the first year postpartum after gestational diabetes

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