Abstract
Background
The proportion of women with previous gestational diabetes mellitus (GDM) receiving
postpartum diabetes testing is far less than desired. Even in health care systems
with high testing rates, some women remain untested. We explored what helps and what
hinders women to obtain recommended testing.
Methods
In this mixed methods study, we recruited 139 patients with a history of GDM in their
most recent pregnancy (6 months to 4.5 years before study enrollment) from a delivery
system that had instituted a quality improvement program to increase postpartum diabetes
testing rates. We determined whether they had received a postpartum diabetes test
according to American Diabetes Association guidelines. Using survey data, we ran logistic
regression models to assess correlates of testing status, and we conducted in-depth
interviews with 22 women to provide greater context to their survey responses.
Results
Of the 139 women, 21 women (15%) did not complete recommended diabetes testing. From
the survey data, women who visited a primary care provider had 72% (95% CI, 0.09–0.83)
lesser odds of not having been tested. From the qualitative interviews, difficulty
fitting testing around work and caregiver demands were the most common reasons for
not testing. Untested women interpreted providers' reassurances that diabetes would
resolve after delivery and lack of reminders to reschedule missed appointments and
to complete diabetes testing as indicators that their physicians were not concerned
about their diabetes risk.
Conclusions
Among hard-to-reach women, multiple demands on their time were common explanations
for not receiving a postpartum diabetes test. Consistent messages regarding long-term
diabetes risk during pregnancy, access to postpartum primary care and convenient lab
appointments, and systematic reminders to providers and patients are approaches that,
in combination, may influence more resistant women to test.
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Biography
Kathryn A. Paez, RN, PhD, is a principal researcher in Health Policy and Research at the American Institutes for Research. Her research interests concern improving quality of care and access to care to improve population health.
Biography
Emma M. Eggleston, MD, MPH, is an instructor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute. Her clinical and research interests are in diabetes, pregnancy, and vascular disease.
Biography
Susan J. Griffey, DrPH, BSN, directs the Evaluation Center at Social & Scientific Systems. She researches public health interventions and programs in the US and in global development settings in primary and reproductive health care, HIV/AIDS, and chronic diseases.
Biography
Brandy Farrar, PhD, is a researcher in Health Policy and Research at the American Institutes for Research. The majority of Ms. Farrar's research involves evaluating the effectiveness, viability, and impact of innovative programs designed to improve quality, access, and capacity of health care services.
Biography
Jacquelyn Smith, MA, is a senior survey manager at Social & Scientific Systems. She applies her 20 years of experience in survey methodology and survey operational management to numerous public health studies in both acute and chronic disease topics.
Biography
Jennifer Thompson, MPP, is a project manager in the Obesity Prevention Program in the Department of Population Medicine at the Harvard Pilgrim Health Care institute and Harvard Medical School. Her projects focus on diabetes, early childhood nutrition, and obesity.
Biography
Matthew Gillman, MD, SM, is a Professor and Director of the Obesity Prevention Program, which seeks to lessen the burden of obesity and its consequences, in the Department of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School.
Article info
Publication history
Accepted:
April 21,
2014
Received in revised form:
April 11,
2014
Received:
October 12,
2013
Footnotes
The authors are grateful for the financial support from the National Institute of Diabetes and Digestive and Kidney Diseases under contract number GS10F0381, purchase number HHSN276201000389U. We would like to acknowledge Sheryl Rifas-Shiman, MPH (Senior Research Analyst, Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute), for analyzing the diabetes testing and survey data, and Karen McCowen, MD (Assistant Professor, Endocrinologist, Harvard Vanguard Medical Associates and Harvard Medical School during the study), for serving as the HVMA liaison to the study and assisting with verification of the diabetes testing data. The authors declare that they have no competing interests. Kathryn Paez, the corresponding author of this manuscript, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Identification
Copyright
© 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
