Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy, Mail Stop S107-3, Atlanta, GA 30341, USA.
American Medical Association, 330 N. Wabash Avenue, Suite 39300, Chicago, IL 60611, USA.
Prev Med. 2021 Aug;149:106614. doi: 10.1016/j.ypmed.2021.106614. Epub 2021 May 11.
Despite evidence of the effectiveness of behavioral change interventions for type 2 diabetes prevention, health care provider referrals to organizations offering the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) remain suboptimal. This study examined facilitators of LCP referrals among primary care providers and pharmacists (providers). We analyzed data on 1956 providers from 2016 to 2017 DocStyles web-based surveys. Pearson chi-square or Fisher's exact tests were used for bivariate associations between facilitators, provider characteristics, and their self-reported referral and bi-directional referral (where they received patient status updates back from the LCPs) to an LCP. Multiple logistic regressions were used to estimate the effects of facilitators to referral practices, controlling for providers' characteristics. Geocoding was done at the street level for in-person, public LCP class locations and at the zip code level for survey respondents to create a density measure for LCP availability within 10 miles. Overall, 21% of providers referred their patients with prediabetes to LCPs, and 6.4% engaged in bi-directional referral. Provider practices that established clinical-community linkages (CCLs) with LCPs (AOR = 4.88), used electronic health records (EHRs) to manage patients (AOR = 2.94), or practiced within 10 miles of an in-person, public LCP class location (AOR = 1.49) were more likely to refer. Establishing CCLs with LCPs (AOR = 8.59) and using EHRs (AOR = 1.86) were also facilitators of bi-directional referral. This study highlights the importance of establishing CCLs between provider settings and organizations offering the National DPP LCP, increasing use of EHRs to manage patients, and increasing availability of in-person LCP class locations near provider practices.
尽管有证据表明行为改变干预措施对 2 型糖尿病预防有效，但医疗保健提供者向提供国家糖尿病预防计划（National DPP）生活方式改变计划（LCP）的组织转介仍然不理想。本研究调查了初级保健提供者和药剂师（提供者）中 LCP 转介的促进因素。我们分析了 2016 年至 2017 年 DocStyles 网络调查中 1956 名提供者的数据。Pearson 卡方检验或 Fisher 精确检验用于比较促进因素、提供者特征与其自我报告的转介和双向转介（他们从 LCP 收到患者状态更新）之间的双变量关联。使用多变量逻辑回归估计促进因素对转介实践的影响，控制提供者的特征。地理编码在街道层面上进行，用于面对面的公共 LCP 课程地点，并在邮政编码层面上为调查受访者进行，以创建 LCP 可及性的密度测量，距离为 10 英里。总体而言，21%的提供者将其患有前驱糖尿病的患者转介到 LCP，6.4%的人进行双向转介。与 LCP 建立临床社区联系（CCL）的提供者实践（AOR=4.88）、使用电子健康记录（EHR）管理患者（AOR=2.94）或在面对面公共 LCP 课程地点 10 英里范围内执业（AOR=1.49）更有可能转介。与 LCP 建立 CCL（AOR=8.59）和使用 EHR（AOR=1.86）也是双向转介的促进因素。本研究强调了在提供者环境和提供 National DPP LCP 的组织之间建立 CCL、增加使用 EHR 管理患者以及增加提供者实践附近面对面 LCP 课程地点的可用性的重要性。
