Primary Care Providers’ Prediabetes Screening, Testing, and Referral Behaviors

Nhim, Kunthea; Khan, Tamkeen; Gruss, Stephanie; Wozniak, Gregory; Kirley, Kate; Schumacher, Patricia; Luman, Elizabeth T.; Albright, Ann

doi:10.1016/j.amepre.2018.04.017

Cited by 45 publications

(51 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our respondents' DPP awareness was similar to that reported in the 2016 national survey of primary care physicians. 20 Low DPP awareness may be due to the relatively recent rollout of the National DPP and scale-up of organizations offering the DPP. Community organizations or local health departments may host DPPs, and clinicians may have limited awareness of community-based patient resources.…”

Section: Discussionmentioning

confidence: 99%

“…About two thirds of clinicians indicated that they referred 25% to 50% of their patients with prediabetes which is similar to the 23% of primary care clinicians who reported making a DPP referral in the 2016 national survey. 20 At the time of the EHR review, an electronic DPP referral did not exist and there was no process for referring patients to the 2 local DPPs. Some clinicians may have discussed DPPs with patients: however, this was not captured as part of our EHR review.…”

Section: Discussionmentioning

confidence: 99%

“…When patients with prediabetes are identified, referrals through primary care have successfully enrolled patients in DPPs 16,17 ; however, reported referral coverage has been less than 5% of eligible patients. 11,18 Despite strong marketing and implementation efforts, 19 clinicians often have limited DPP awareness, 20 may believe patients lack motivation for such programs, 15 and often lack clear referral processes to such services. 12 Studies show that when clinicians make patients aware of their prediabetes the likelihood of lifestyle change increases, 5,21 yet few clinicians routinely refer patients to DPPs.…”

mentioning

confidence: 99%

“…12 Studies show that when clinicians make patients aware of their prediabetes the likelihood of lifestyle change increases, 5,21 yet few clinicians routinely refer patients to DPPs. 11,20,22,23 We designed an implementation study with the objective of increasing DPP referrals in a family medicine clinic. To inform our implementation strategy and establish a baseline of prediabetes practices we assessed clinician knowledge, attitudes, and practices regarding prediabetes and reviewed electronic health records (EHRs) for prediabetes screening, diagnosis and treatment in our patient population.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Prediabetes Knowledge, Attitudes, and Practices at an Academic Family Medicine Practice

et al. 2019

View full text Add to dashboard Cite

Lifestyle change programs are an effective but underutilized approach to prevent or delay type 2 diabetes in people with prediabetes. Understanding clinician prediabetes knowledge, attitudes, and practices can inform implementation efforts to increase lifestyle change program referrals. Methods: We surveyed clinicians at an academic family medicine clinic about their prediabetes knowledge, attitudes, and practices. From the same clinic, we reviewed electronic health records to assess prediabetes screening, diagnosis, and treatment coverage in the cohort of adults seen from 2015 to 2017. Results: Thirty-one clinicians (69.6%) completed the survey. Clinicians believed prediabetes was an important health issue (n ‫؍‬ 29; 93.7%) and that prediabetes screening (n ‫؍‬ 20, 64.5%) and diagnosis (n ‫؍‬ 31, 100%) were important for prediabetes management. About half of the respondents (n ‫؍‬ 14; 45.2%) reported familiarity with the National Diabetes Prevention Program (DPP). Electronic chart review included 15,520 adult patients. Most of the 5360 nondiabetic patients meeting US Preventive Services Task Force diabetes screening guidelines (n ‫؍‬ 4068; 75.9%) received a hemoglobin A1c test. Of the 1437 patients with an A1c result diagnostic of prediabetes, 729 (50.7%) had the diagnosis in their chart. Prediabetes patients receiving point-of-care A1c testing instead of laboratory testing had 4.7 increased odds (95% CI, 3.5 to 6.4) of metformin prescription. No patients were referred to a DPP. Conclusions: Clinicians' positive attitudes toward prediabetes screening, moderate knowledge of prediabetes management, and low awareness of DPPs were reflected by high diabetes screening coverage, limited prediabetes diagnosis, and no DPP referrals. We will tailor our implementation strategy to overcome these prediabetes care barriers.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Prediabetes Knowledge, Attitudes, and Practices at an Academic Family Medicine Practice

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Those with elevated risk scores are advised to contact their healthcare provider for a diabetes screening test and/or enroll in an evidencebased diabetes prevention program. Although the uptake of these risk scores in community settings is unknown, their use in clinical practice is low [39]. This may, in part, reflect challenges of automating these tools within electronic health records (EHRs) due to risk factors that are not systematically captured in structured data fields (e.g., physical activity) [40].…”

Section: Diabetes Risk Assessment: Identifying High-risk Individuals mentioning

confidence: 99%

Building Toward a Population-Based Approach to Diabetes Screening and Prevention for US Adults

et al. 2018

View full text Add to dashboard Cite

Awareness of diabetes risk is low, and many adults with prediabetes are not identified through existing screening efforts. Accumulating evidence and policies support expansion of the Diabetes Prevention Program (DPP) into clinical and community settings. However, the infrastructure to facilitate referrals and promote data exchange among patients, clinical settings, and community-based DPP programs is lacking. Development of evidence-driven, scalable processes for assessing diabetes risk, screening eligible adults, and delivering preventive treatments are needed to effectively improve the glycemic health of the US adult population.

show abstract

Reach and Use of Diabetes Prevention Services in the United States, 2016-2017

et al. 2019

View full text Add to dashboard Cite

Key Points Question What number and proportion of US adults are referred to and use diabetes preventive services? Findings In this nationally representative cross-sectional analysis of 50 912 survey respondents, 73.5% of those with diagnosed prediabetes and 50.6% of those with risk factors reported receiving any advice or referrals to reduce risk; of those advised, 35.0% to 75.8% of those with diagnosed prediabetes and 33.5% to 75.2% with risk factors reported engaging in various risk-reducing activities or programs in the past year. Those with a formal prediabetes diagnosis were more likely to receive advice or referrals by health care professionals, and those advised were more likely to engage in risk-reducing activities and/or programs. Meaning To improve reach and use of diabetes preventive services, expansion of some combination of programs (supply), awareness (demand), and access and referrals by health care professionals (linkage) appears to be needed.

show abstract

Primary Care Providers’ Prediabetes Screening, Testing, and Referral Behaviors

Abstract: This study highlights the importance of increasing primary care provider awareness of and referrals to the CDC-recognized lifestyle change program.

Cited by 45 publications

References 29 publications

Prediabetes Knowledge, Attitudes, and Practices at an Academic Family Medicine Practice

Prediabetes Knowledge, Attitudes, and Practices at an Academic Family Medicine Practice

Building Toward a Population-Based Approach to Diabetes Screening and Prevention for US Adults

Reach and Use of Diabetes Prevention Services in the United States, 2016-2017

Contact Info

Product

Resources

About