UMDNJ-Robert Wood Johnson Medical School, Jersey Shore University Medical Center, Department of Medicine, Ackerman 3, 1945 Route 33, Neptune, NJ 07753, United States.
Prim Care Diabetes. 2013 Oct;7(3):177-86. doi: 10.1016/j.pcd.2013.04.007. Epub 2013 May 15.
Gestational diabetes mellitus (GDM) is increasing and 30% have persistent postpartum dysglycemia. Reported compliance with recommended postpartum testing ranges 9-95% without a clear explanation for this wide variation. Small and conflicting differences in testing rates are associated with some demographics (race, use of insulin), but system factors likely play a larger role. A systematic literature review was performed to identify system based factors that could explain the broad variation in postpartum GDM testing rates.
Original articles reporting postpartum testing rates among women with GDM were identified within PubMed, OVID, EMBASE, and the Cochrane Database of systematic reviews. Articles that did not report rates for the entire GDM cohort were excluded.
54/307 citations met inclusion criteria. The use of proactive patient contact programs increased postpartum testing rates from an average of 33% (range 9-71%) up to 60% (range 14-95%).
Proactively contacting patients via phone calls, education programs, or postal reminders was associated with higher postpartum testing rates. Rather than working to identifying individual demographic factors, systems based approaches were associated with a larger potential impact, and appear easily generalizable. Clinicians should think beyond individual habits and consider systematic approaches to improving testing rates.
妊娠糖尿病(GDM)的发病率正在上升,其中 30%的患者在产后仍存在糖代谢异常。据报道,建议的产后检查的依从率为 9-95%,但对于这种广泛的变异性,没有明确的解释。检测率的微小且相互矛盾的差异与一些人口统计学因素(种族、胰岛素使用)有关,但系统因素可能起更大的作用。本系统文献回顾旨在确定可能解释产后 GDM 检测率广泛变化的基于系统的因素。
在 PubMed、OVID、EMBASE 和 Cochrane 系统评价数据库中,确定了报道 GDM 女性产后检测率的原始文章。未报告整个 GDM 队列检测率的文章被排除在外。
54/307 条引文符合纳入标准。主动的患者联系计划使产后检测率从平均 33%(范围 9-71%)增加到 60%(范围 14-95%)。
通过电话、教育计划或邮寄提醒主动联系患者与更高的产后检测率相关。基于系统的方法与更大的潜在影响相关,而且似乎易于推广,而不是努力确定个体人口统计学因素。临床医生应该超越个体习惯,考虑系统方法来提高检测率。