Stephenson-Hunter Cara, Gonzalez Christopher J, Franco Stacey, Hashmi Maryam, Tisor Ochuwa, Gonzalez Cristina M
Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
General Internal Medicine, Weill Cornell Medicine, New York, New York, USA.
BMJ Nutr Prev Health. 2024 Aug 3;7(2):e000932. doi: 10.1136/bmjnph-2024-000932. eCollection 2024.
Despite the effectiveness of Diabetes Prevention Programmes (DPP) in reducing diabetes risk, primary care provider (PCP) referrals remain low, especially among men and racial/ethnic minorities, exacerbating their under-representation in DPPs. Understanding PCPs' perspectives on referrals is crucial for enhancing the intervention's reach and effectiveness.
We conducted a qualitative study to explore PCPs' experiences, perspectives and engagement with DPP referrals, focusing on factors influencing variations in referral rates. Based on electronic record data, high and low-referring PCPs from a large integrated health system in the Bronx, NY, participated in interviews conducted between February and September 2023. Interviews were conducted and recorded on Zoom, anonymised, transcribed and analysed using the constant comparative method.
From 22 PCP interviews, 4 themes emerged representing factors that influenced referrals: (1) perceived barriers to the patient engagement with the DPP, including infrastructure gaps, programme accessibility issues and unmet social needs, particularly affecting low-referring PCPs; (2) perceived effectiveness of the DPP, with concerns raised about its efficacy, especially for male and socioeconomically disadvantaged patients; (3) perceived self-efficacy in referring patients, driven by knowledge gaps and limited opportunities, especially among low-referrers and (4) recommendations to facilitate and strengthen referrals, highlighting areas for PCP and patient support. The perspectives of high-referring/low-referring PCPs often differed across these themes and associated subthemes.
Our research illuminates the challenges PCPs face in treating prediabetic patients and factors influencing DPP referrals in underserved populations. This understanding can guide interventions to enhance equitable DPP referrals and engagement, thereby reducing diabetes risk in vulnerable populations.
尽管糖尿病预防计划（DPP）在降低糖尿病风险方面具有成效，但初级保健提供者（PCP）的转诊率仍然很低，尤其是在男性以及少数种族/族裔群体中，这加剧了他们在DPP中的代表性不足。了解初级保健提供者对转诊的看法对于扩大干预措施的覆盖范围和提高其有效性至关重要。
我们进行了一项定性研究，以探讨初级保健提供者在DPP转诊方面的经历、观点和参与情况，重点关注影响转诊率差异的因素。基于电子记录数据，来自纽约布朗克斯区一个大型综合医疗系统的高转诊率和低转诊率初级保健提供者参与了2023年2月至9月期间进行的访谈。访谈在Zoom上进行并录制，匿名处理，转录后使用持续比较法进行分析。
通过对22名初级保健提供者的访谈，出现了4个主题，代表了影响转诊的因素：（1）患者参与DPP的感知障碍，包括基础设施差距、项目可及性问题和未满足的社会需求，尤其影响低转诊率的初级保健提供者；（2）对DPP有效性的感知，对其疗效存在担忧，特别是对男性和社会经济弱势患者；（3）转诊患者的自我效能感，受知识差距和机会有限的影响，尤其是在低转诊率提供者中；（4）促进和加强转诊的建议，突出了初级保健提供者和患者支持的领域。在这些主题及相关子主题中，高转诊率/低转诊率初级保健提供者的观点往往存在差异。
我们的研究揭示了初级保健提供者在治疗糖尿病前期患者时面临的挑战以及影响服务不足人群中DPP转诊的因素。这种理解可以指导干预措施，以提高DPP转诊的公平性和参与度，从而降低弱势群体中的糖尿病风险。
