Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia.
American Medical Association, Chicago, Illinois.
Am J Prev Med. 2018 Aug;55(2):e39-e47. doi: 10.1016/j.amepre.2018.04.017. Epub 2018 Jun 20.
Intensive behavioral counseling is effective in preventing type 2 diabetes, and insurance coverage for such interventions is increasing. Although primary care provider referrals are not required for entry to the Centers for Disease Control and Prevention (CDC)-recognized National Diabetes Prevention Program lifestyle change program, referral rates remain suboptimal. This study aims to assess the association between primary care provider behaviors regarding prediabetes screening, testing, and referral and awareness of the CDC-recognized lifestyle change program and the Prevent Diabetes STAT: Screen, Test, and Act Today toolkit. Awareness of the lifestyle change program and the STAT toolkit, use of electronic health records, and the ratio of lifestyle change program classes to primary care physicians were hypothesized to be positively associated with primary care provider prediabetes screening, testing, and referral behaviors.
Responses from primary care providers (n=1,256) who completed the 2016 DocStyles cross-sectional web-based survey were analyzed in 2017 to measure self-reported prediabetes screening, testing, and referral behaviors. Multivariate logistic regression was used to estimate the effects of primary care provider awareness and practice characteristics on these behaviors, controlling for provider characteristics.
Overall, 38% of primary care providers were aware of the CDC-recognized lifestyle change program, and 19% were aware of the STAT toolkit; 27% screened patients for prediabetes using a risk test; 97% ordered recommended blood tests; and 23% made referrals. Awareness of the lifestyle change program and the STAT toolkit was positively associated with screening and referring patients. Primary care providers who used electronic health records were more likely to screen, test, and refer. Referring was more likely in areas with more lifestyle change program classes.
This study highlights the importance of increasing primary care provider awareness of and referrals to the CDC-recognized lifestyle change program.
强化行为咨询在预防 2 型糖尿病方面非常有效，而且此类干预措施的保险覆盖范围正在扩大。尽管不需要初级保健提供者转诊即可参加疾病控制与预防中心（CDC）认可的国家糖尿病预防计划生活方式改变计划，但转诊率仍然不理想。本研究旨在评估初级保健提供者在糖尿病前期筛查、检测和转诊方面的行为与对 CDC 认可的生活方式改变计划和预防糖尿病 STAT：今日筛查、检测和行动工具包的认识之间的关系。假设对生活方式改变计划和 STAT 工具包的认识、使用电子健康记录以及生活方式改变计划课程与初级保健医生的比例与初级保健提供者的糖尿病前期筛查、检测和转诊行为呈正相关。
2017 年分析了 2016 年 DocStyles 横断面网络调查中完成调查的 1256 名初级保健提供者的回复，以衡量自我报告的糖尿病前期筛查、检测和转诊行为。使用多变量逻辑回归来估计初级保健提供者意识和实践特征对这些行为的影响，同时控制提供者特征。
总体而言，38%的初级保健提供者了解 CDC 认可的生活方式改变计划，19%的人了解 STAT 工具包；27%的人使用风险测试筛查糖尿病前期患者；97%的人开出了推荐的血液检测；23%的人进行了转诊。对生活方式改变计划和 STAT 工具包的认识与筛查和转诊患者呈正相关。使用电子健康记录的初级保健提供者更有可能进行筛查、检测和转诊。在有更多生活方式改变计划课程的地区，转诊的可能性更大。
本研究强调了提高初级保健提供者对 CDC 认可的生活方式改变计划的认识和转诊的重要性。
