Hafez Dina, Nelson Daniel B, Martin Evan G, Cohen Alicia J, Northway Rebecca, Kullgren Jeffrey T
VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 14, Room G100-36, Ann Arbor, MI, 48109-2800, USA.
Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI, USA.
BMC Fam Pract. 2017 Apr 4;18(1):50. doi: 10.1186/s12875-017-0623-3.
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.
糖尿病前期和2型糖尿病（T2DM）的早期诊断和治疗可预防未来的健康问题，但许多患有这些疾病的个体未被诊断出来。这在一定程度上可能归因于初级保健医生（PCP）的筛查做法，而对此了解甚少。本研究的目的是确定影响初级保健医生对患者进行T2DM筛查决策的因素，并描述他们对筛查测试结果的解读以及与患者的沟通情况。
我们对20名密歇根大学健康系统（UMHS）的初级保健医生进行了半结构化的图表刺激回忆访谈。向初级保健医生询问他们最近对134名符合美国糖尿病协会T2DM筛查标准的非糖尿病患者进行筛查或不筛查的决定。访谈进行了录音、转录，并使用定性定向内容分析法进行分析。患者人口统计学特征和合并症的数据从电子健康记录中提取。
初级保健医生不筛查63名患者T2DM的最常见原因是知晓先前筛查测试结果正常（49%）以及因健康维护检查以外的原因就诊（48%）。初级保健医生筛查71名患者T2DM的最常见原因是知晓先前筛查测试结果异常（49%）、患者体重（42%）和年龄（38%）。初级保健医生正确解读了89%的筛查测试结果，并将95%的测试结果告知了患者。在24名被发现患有糖尿病前期的患者中，初级保健医生通常（58%）建议减肥和增加体育活动，但从未建议参加糖尿病预防计划或使用二甲双胍。
先前的筛查测试结果、就诊类型以及患者的体重和年龄影响了初级保健医生对T2DM的筛查决策。当对患者进行筛查时，测试结果通常得到正确解读并一致传达。对糖尿病前期患者的建议可以更好地反映预防T2DM的循证策略。
