Study protocol for a mixed methods exploratory investigation of aftercare services for gestational diabetes in women to develop a new patient-centred model in Germany: the GestDiNa_basic study

Abstract

IntroductionWomen with gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes mellitus compared with women who never had GDM. Consequently, the question of structured aftercare for GDM has emerged. In all probability, many women do not receive care according to the guidelines. In particular, the process and interaction between obstetrical, diabetic, gynaecological, paediatric and general practitioner care lacks clear definitions. Thus, our first goal is to analyse the current aftercare situation for women with GDM in Germany, for example, the participation rate in aftercare diabetes screening, as well as reasons and attitudes stated by healthcare providers to offer these services and by patients to participate (or not). Second, we want to develop an appropriate, effective and patient-centred care model.Methods and analysisThis is a population-based mixed methods study using both quantitative and qualitative research approaches. In various working packages, we evaluate data of the GestDiab register, of the Association of Statutory Health Insurance Physicians of North Rhine and the participating insurance companies (AOK Rheinland/Hamburg, BARMER, DAK Gesundheit, IKK classic, pronova BKK). In addition, quantitative (postal surveys) and qualitative (interviews) surveys will be conducted with randomly selected healthcare providers (diabetologists, gynaecologists, paediatricians and midwives) and affected women, to be subsequently analysed. All results will then be jointly examined and evaluated.Ethics and disseminationThe study was approved by the ethics committee of the Faculty of Medicine, Heinrich-Heine-University Düsseldorf (Ethics Committee No.: 2019-738). Participants of the postal surveys and interviews will be informed in detail about the study and the use of data as well as the underlying data protection regulations before voluntarily participating. The study results will be disseminated through peer-reviewed journals, conferences and public information.Trial registration numberDRKS00020283.

Postpartum screening of women with GDM in specialised practices: Data from 12,991 women in the GestDiab register

“…Further research should investigate barriers and enabling factors from a patient point of view as well as from the health‐care providers’ point of view to develop a multilevel approach for GDM postpartum care. Using registry data or a mixed‐methods approach will potentially help to achieve this objective 24,25 …”

Updates on Gestational Diabetes

“…GDM is diagnosed if glucose levels are ≥92 mg/dL (5.1 mmol/L) fasting, ≥180 mg/dL (10 mmol/L) after 1 hour, or ≥153 mg/dL (8, 5 mmol/L) after 2 hours. 4 Women with diagnosed GDM are recommended to have a glucose tolerance test 6-12 weeks postpartum. The National Health Guidelines, in the German country, indicate reference to a center for screening and diagnosis, treatment and postpartum care.…”

“…Women with GDM are at increased risk of cardiovascular events, and their children are predisposed to the future risk of obesity and T2DM. 2,4,5 Evan et al 3 recently concluded, in qualitative research, that there are perceptions around GDM that, if not addressed, are likely to compromise the effect of lifestyle interventions. For example, although many women know that there is an association between GDM and T2D in their future, they may not understand this risk as GDM has minimal and transient impact on their lives.…”

Introduction to methodology for the development of an integrative medical service model

“…7 , 8 , 9 However, because the level and scope of models and programs are diverse, it is limited to provide integrative medical services to patients with four major diseases with one program, and calling this an integrative medical service also has limitations. 10 , 11 This means that the concept of integrated medical services in Korea is not yet clear, and individual researchers and medical staff are conceptualizing integrated medical services with their own operational definitions. In particular, the terms “integrated medical care”, “medical service”, and “service model” are conceptualized differently for each medical person, and are sometimes not scientific.…”