Lithgow Georgina E, Rossi Jasper, Griffin Simon J, Usher-Smith Juliet A, Dennison Rebecca A
School of Clinical Medicine, University of Cambridge, Cambridge.
MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge.
Br J Gen Pract. 2021 May 27;71(707):e473-e482. doi: 10.3399/BJGP.2020.0928. Print 2021 Jun.
Gestational diabetes mellitus (GDM) is an important risk factor for developing type 2 diabetes mellitus (T2DM) later in life. Postpartum screening provides an opportunity for early detection and management of T2DM, but uptake is poor.
To explore barriers to screening from clinicians' perspectives to guide future interventions to increase uptake of postpartum screening.
Systematic review and qualitative synthesis.
Qualitative studies included in a previous review were assessed, and then five electronic databases were searched from January 2013 to May 2019 for qualitative studies reporting clinicians' perspectives on postpartum glucose screening after GDM. Study quality was assessed against the Critical Appraisal Skills Programmes checklist. Qualitative data from the studies were analysed using thematic synthesis.
Nine studies were included, containing views from 187 clinicians from both community and hospital care. Three main themes were identified: difficulties in handover between primary and secondary care (ambiguous roles and communication difficulties); short-term focus in clinical consultations (underplaying risk so as not to overwhelm patients and competing priorities); and patient-centric barriers such as time pressures.
Barriers to diabetes screening were identified at both system and individual levels. At the system level, clarification of responsibility for testing among healthcare professionals and better systems for recall are needed. These could be achieved through registers, improved clinical protocols, and automatic flagging and prompts within electronic medical records. At the individual level, clinicians should be supported to prioritise the importance of screening within consultations and better educational resources made available for women. Making it more convenient for women to attend may also facilitate screening.
妊娠期糖尿病（GDM）是日后发生2型糖尿病（T2DM）的重要危险因素。产后筛查为T2DM的早期发现和管理提供了机会，但筛查率很低。
从临床医生的角度探讨筛查的障碍，以指导未来提高产后筛查率的干预措施。
系统评价和定性综合分析。
对先前综述中纳入的定性研究进行评估，然后检索2013年1月至2019年5月的五个电子数据库，查找报告临床医生对GDM后产后血糖筛查看法的定性研究。根据批判性评估技能计划清单评估研究质量。使用主题综合分析法分析研究中的定性数据。
纳入9项研究，包含来自社区和医院护理的187名临床医生的观点。确定了三个主要主题：初级和二级护理之间交接困难（角色不明确和沟通困难）；临床会诊关注短期问题（淡化风险以免让患者不堪重负以及存在相互竞争的优先事项）；以及以患者为中心的障碍，如时间压力。
在系统和个人层面都发现了糖尿病筛查的障碍。在系统层面，需要明确医疗保健专业人员之间的检测责任，并建立更好的召回系统。这可以通过登记册、改进的临床方案以及电子病历中的自动标记和提示来实现。在个人层面，应支持临床医生在会诊中优先考虑筛查的重要性，并为女性提供更好的教育资源。让女性就诊更方便也可能促进筛查。
