Rosedale Mary T, Strauss Shiela M, Kaur Navjot, Danoff Ann, Malaspina Dolores
New York University Rory Meyers College of Nursing, NY, NY.
NYU Langone Medical Center, NY, NY.
Int J Ment Health. 2018;47(1):64-73. doi: 10.1080/00207411.2017.1377803. Epub 2017 Oct 2.
The risk for diabetes risk is significantly elevated in persons who are older, overweight and have serious mental illness. However, primary care practitioners (PCP) tend to underestimate this risk. Although there are few opportunities for early detection of diabetes, blood exuded during routine oral exams in dental settings can be used to assess glycated hemoglobin (HbA1c) levels. The current study sought to understand how primary care practitioners would react to patients who screened positive for elevated HbA1c, how they estimated risk, and whether they provided treatment recommendations or counseling.
Semi-structured telephone interviews were conducted on 61 subjects three months after demonstrating elevated HbA1c levels from dental screenings. Data were transcribed and analyzed using content analysis.
Qualitative analyses revealed four themes according to patients: (1) "Being told I needed to make lifestyle changes" (41%); (2) Realizing I needed a new health care provider or medication change" (10%); (3) "Being told of the need for monitoring but no counseling/treatment change" (16%); and (4) "Being told everything is fine and there is nothing to worry about" (31%).
Only half of the 61 cases reporting elevated HbA1C levels at screening experienced their PCP's as responding with counseling or medication changes. Almost a third of cases perceived that their PCP's dismissed the results, making no recommendations, and the rest perceived no counseling or interventions being proposed. Based on subjects' perceptions of their PCP's responses to their elevated HbA1c values, the impact of this intervention is substantially reduced over expectations.
年龄较大、超重且患有严重精神疾病的人群患糖尿病的风险显著升高。然而，初级保健医生（PCP）往往低估了这种风险。尽管早期发现糖尿病的机会很少，但在牙科环境中进行常规口腔检查时渗出的血液可用于评估糖化血红蛋白（HbA1c）水平。本研究旨在了解初级保健医生对HbA1c升高筛查呈阳性的患者会有何反应，他们如何估计风险，以及是否提供治疗建议或咨询。
在牙科筛查显示HbA1c水平升高三个月后，对61名受试者进行了半结构化电话访谈。使用内容分析法对数据进行转录和分析。
定性分析根据患者揭示了四个主题：（1）“被告知我需要改变生活方式”（41%）；（2）“意识到我需要更换医疗服务提供者或改变药物”（10%）；（3）“被告知需要监测但无需改变咨询/治疗”（16%）；以及（4）“被告知一切正常，无需担心”（31%）。
在筛查时报告HbA1C水平升高的61例病例中，只有一半的患者认为其初级保健医生会提供咨询或改变药物治疗。近三分之一的病例认为其初级保健医生对结果不予理会，未提出任何建议，其余病例则认为未得到任何咨询或干预建议。根据受试者对其初级保健医生对其升高的HbA1c值的反应的看法，这种干预的影响大大低于预期。
