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Feasibility, acceptability and uptake rates of gestational diabetes mellitus screening in primary care vs secondary care: findings from a randomised controlled mixed methods trial
Aims/hypothesis It is postulated that uptake rates for gestational diabetes mellitus (GDM) screening would be improved if offered in a setting more accessible to the patient. The aim of this study was to evaluate the proportion of uptake of GDM screening in the primary vs secondary care setting, and...
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| Published in: | Diabetologia 2015-11, Vol.58 (11), p.2486-2493 |
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| container_issue | 11 |
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| container_title | Diabetologia |
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| creator | Tierney, Marie O’Dea, Angela Danyliv, Andriy Glynn, Liam G. McGuire, Brian E. Carmody, Louise A Newell, John Dunne, Fidelma P. |
| description | Aims/hypothesis
It is postulated that uptake rates for gestational diabetes mellitus (GDM) screening would be improved if offered in a setting more accessible to the patient. The aim of this study was to evaluate the proportion of uptake of GDM screening in the primary vs secondary care setting, and to qualitatively explore the providers’ experiences of primary care screening provision.
Methods
This mixed methods study was composed of a quantitative unblinded parallel group randomised controlled trial and qualitative interview trial. The primary outcome was the proportion of uptake of screening in both the primary and secondary care settings. All pregnant women aged 18 years or over, with sufficient English and without a diagnosis or diabetes or GDM, who attended for their first antenatal appointment at one of three hospital sites along the Irish Atlantic seaboard were eligible for inclusion in this study. Seven hundred and eighty-one pregnant women were randomised using random permutated blocks to receive a 2 h 75 g OGTT in either a primary (
n
= 391) or secondary care (
n
= 390) setting. Semi-structured interviews were conducted with 13 primary care providers. Primary care providers who provided care to the population covered by the three hospital sites involved were eligible for inclusion.
Results
Statistically significant differences were found between the primary care (
n
= 391) and secondary care (
n
= 390) arms for uptake (52.7% vs 89.2%, respectively; effect size 36.5 percentage points, 95% CI 30.7, 42.4;
p
|
| doi_str_mv | 10.1007/s00125-015-3713-6 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1718903580</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3822845261</sourcerecordid><originalsourceid>FETCH-LOGICAL-c485t-2b7b73ac9cd702ea542319aa00452ce9ad1df22a40f26eaf3927eb25b6f9b38d3</originalsourceid><addsrcrecordid>eNp1kctuFTEMhiNERQ-FB2CDIrFhwZTc5sYOVRSQKrEBid3Ik3gOKTPJIZlB9Ln6gniYU4QqsUli-7Md-2fsmRTnUoj6dRZCqrIQsix0LXVRPWA7abQqhFHNQ7Zbw4Vsqq-n7HHO10IIXZrqETtVlTKqMmbHbi8Rsu_96OebVxysxcMMm8khOL6Q-R15ghkzjwPfY55h9jHAyJ2HHlf_hCMlLJlnmxCDD3vuAz8kP0G64RYS8p8URBuDu_O84YMPjtDMhxQnDtQjuDj5jI4TOKc4jvSc_K_1xPlbdJnPycP4hJ0MMGZ8erzP2JfLd58vPhRXn95_vHh7VVjTlHOh-rqvNdjWuloohNIoLVsAIUypLLbgpBuUAiMGVSEMulU19qrsq6HtdeP0GXu51T2k-GOhwTv6naVZIWBccidr2bS00kYQ-uIeeh2XREv6Q9VtRZwmSm6UTTHnhEN33FEnRbcq2m2KdqRotyraVZTz_Fh56Sd0fzPuJCRAbUCmUNhj-qf1f6v-Bneir-k</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1717969033</pqid></control><display><type>article</type><title>Feasibility, acceptability and uptake rates of gestational diabetes mellitus screening in primary care vs secondary care: findings from a randomised controlled mixed methods trial</title><source>Springer Nature</source><creator>Tierney, Marie ; O’Dea, Angela ; Danyliv, Andriy ; Glynn, Liam G. ; McGuire, Brian E. ; Carmody, Louise A ; Newell, John ; Dunne, Fidelma P.</creator><creatorcontrib>Tierney, Marie ; O’Dea, Angela ; Danyliv, Andriy ; Glynn, Liam G. ; McGuire, Brian E. ; Carmody, Louise A ; Newell, John ; Dunne, Fidelma P.</creatorcontrib><description>Aims/hypothesis
It is postulated that uptake rates for gestational diabetes mellitus (GDM) screening would be improved if offered in a setting more accessible to the patient. The aim of this study was to evaluate the proportion of uptake of GDM screening in the primary vs secondary care setting, and to qualitatively explore the providers’ experiences of primary care screening provision.
Methods
This mixed methods study was composed of a quantitative unblinded parallel group randomised controlled trial and qualitative interview trial. The primary outcome was the proportion of uptake of screening in both the primary and secondary care settings. All pregnant women aged 18 years or over, with sufficient English and without a diagnosis or diabetes or GDM, who attended for their first antenatal appointment at one of three hospital sites along the Irish Atlantic seaboard were eligible for inclusion in this study. Seven hundred and eighty-one pregnant women were randomised using random permutated blocks to receive a 2 h 75 g OGTT in either a primary (
n
= 391) or secondary care (
n
= 390) setting. Semi-structured interviews were conducted with 13 primary care providers. Primary care providers who provided care to the population covered by the three hospital sites involved were eligible for inclusion.
Results
Statistically significant differences were found between the primary care (
n
= 391) and secondary care (
n
= 390) arms for uptake (52.7% vs 89.2%, respectively; effect size 36.5 percentage points, 95% CI 30.7, 42.4;
p
< 0.001), crossover (32.5% vs 2.3%, respectively;
p
< 0.001) and non-uptake (14.8% vs 8.5%, respectively;
p
= 0.005). There were no significant differences in uptake based on the presence of a practice nurse or the presence of multiple general practitioners in the primary care setting. There was evidence of significant relationship between probability of uptake of screening and age (
p
< 0.001). Primary care providers reported difficulties with the conduct of GDM screening, despite recognising that the community was the most appropriate location for screening.
Conclusions/interpretation
Currently, provision of GDM screening in primary care in Ireland, despite its acknowledged benefits, is unfeasible due to poor uptake rates, poor rates of primary care provider engagement and primary care provider concerns.
Trial registration
http://isrctn.org
ISRCTN02232125
Funding
This study was funded by the Health Research Board (ICE2011/03)</description><identifier>ISSN: 0012-186X</identifier><identifier>EISSN: 1432-0428</identifier><identifier>DOI: 10.1007/s00125-015-3713-6</identifier><identifier>PMID: 26242644</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Diabetes, Gestational - diagnosis ; Female ; Gestational diabetes ; Glucose ; Glucose Tolerance Test ; Health Services Accessibility ; Human Physiology ; Humans ; Internal Medicine ; Ireland ; Mass Screening ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Mixed methods research ; Patient Acceptance of Health Care ; Pregnancy ; Primary care ; Primary Health Care ; Secondary Care ; Womens health ; Young Adult</subject><ispartof>Diabetologia, 2015-11, Vol.58 (11), p.2486-2493</ispartof><rights>Springer-Verlag Berlin Heidelberg 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c485t-2b7b73ac9cd702ea542319aa00452ce9ad1df22a40f26eaf3927eb25b6f9b38d3</citedby><cites>FETCH-LOGICAL-c485t-2b7b73ac9cd702ea542319aa00452ce9ad1df22a40f26eaf3927eb25b6f9b38d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26242644$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tierney, Marie</creatorcontrib><creatorcontrib>O’Dea, Angela</creatorcontrib><creatorcontrib>Danyliv, Andriy</creatorcontrib><creatorcontrib>Glynn, Liam G.</creatorcontrib><creatorcontrib>McGuire, Brian E.</creatorcontrib><creatorcontrib>Carmody, Louise A</creatorcontrib><creatorcontrib>Newell, John</creatorcontrib><creatorcontrib>Dunne, Fidelma P.</creatorcontrib><title>Feasibility, acceptability and uptake rates of gestational diabetes mellitus screening in primary care vs secondary care: findings from a randomised controlled mixed methods trial</title><title>Diabetologia</title><addtitle>Diabetologia</addtitle><addtitle>Diabetologia</addtitle><description>Aims/hypothesis
It is postulated that uptake rates for gestational diabetes mellitus (GDM) screening would be improved if offered in a setting more accessible to the patient. The aim of this study was to evaluate the proportion of uptake of GDM screening in the primary vs secondary care setting, and to qualitatively explore the providers’ experiences of primary care screening provision.
Methods
This mixed methods study was composed of a quantitative unblinded parallel group randomised controlled trial and qualitative interview trial. The primary outcome was the proportion of uptake of screening in both the primary and secondary care settings. All pregnant women aged 18 years or over, with sufficient English and without a diagnosis or diabetes or GDM, who attended for their first antenatal appointment at one of three hospital sites along the Irish Atlantic seaboard were eligible for inclusion in this study. Seven hundred and eighty-one pregnant women were randomised using random permutated blocks to receive a 2 h 75 g OGTT in either a primary (
n
= 391) or secondary care (
n
= 390) setting. Semi-structured interviews were conducted with 13 primary care providers. Primary care providers who provided care to the population covered by the three hospital sites involved were eligible for inclusion.
Results
Statistically significant differences were found between the primary care (
n
= 391) and secondary care (
n
= 390) arms for uptake (52.7% vs 89.2%, respectively; effect size 36.5 percentage points, 95% CI 30.7, 42.4;
p
< 0.001), crossover (32.5% vs 2.3%, respectively;
p
< 0.001) and non-uptake (14.8% vs 8.5%, respectively;
p
= 0.005). There were no significant differences in uptake based on the presence of a practice nurse or the presence of multiple general practitioners in the primary care setting. There was evidence of significant relationship between probability of uptake of screening and age (
p
< 0.001). Primary care providers reported difficulties with the conduct of GDM screening, despite recognising that the community was the most appropriate location for screening.
Conclusions/interpretation
Currently, provision of GDM screening in primary care in Ireland, despite its acknowledged benefits, is unfeasible due to poor uptake rates, poor rates of primary care provider engagement and primary care provider concerns.
Trial registration
http://isrctn.org
ISRCTN02232125
Funding
This study was funded by the Health Research Board (ICE2011/03)</description><subject>Adult</subject><subject>Diabetes, Gestational - diagnosis</subject><subject>Female</subject><subject>Gestational diabetes</subject><subject>Glucose</subject><subject>Glucose Tolerance Test</subject><subject>Health Services Accessibility</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Ireland</subject><subject>Mass Screening</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Mixed methods research</subject><subject>Patient Acceptance of Health Care</subject><subject>Pregnancy</subject><subject>Primary care</subject><subject>Primary Health Care</subject><subject>Secondary Care</subject><subject>Womens health</subject><subject>Young Adult</subject><issn>0012-186X</issn><issn>1432-0428</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNp1kctuFTEMhiNERQ-FB2CDIrFhwZTc5sYOVRSQKrEBid3Ik3gOKTPJIZlB9Ln6gniYU4QqsUli-7Md-2fsmRTnUoj6dRZCqrIQsix0LXVRPWA7abQqhFHNQ7Zbw4Vsqq-n7HHO10IIXZrqETtVlTKqMmbHbi8Rsu_96OebVxysxcMMm8khOL6Q-R15ghkzjwPfY55h9jHAyJ2HHlf_hCMlLJlnmxCDD3vuAz8kP0G64RYS8p8URBuDu_O84YMPjtDMhxQnDtQjuDj5jI4TOKc4jvSc_K_1xPlbdJnPycP4hJ0MMGZ8erzP2JfLd58vPhRXn95_vHh7VVjTlHOh-rqvNdjWuloohNIoLVsAIUypLLbgpBuUAiMGVSEMulU19qrsq6HtdeP0GXu51T2k-GOhwTv6naVZIWBccidr2bS00kYQ-uIeeh2XREv6Q9VtRZwmSm6UTTHnhEN33FEnRbcq2m2KdqRotyraVZTz_Fh56Sd0fzPuJCRAbUCmUNhj-qf1f6v-Bneir-k</recordid><startdate>20151101</startdate><enddate>20151101</enddate><creator>Tierney, Marie</creator><creator>O’Dea, Angela</creator><creator>Danyliv, Andriy</creator><creator>Glynn, Liam G.</creator><creator>McGuire, Brian E.</creator><creator>Carmody, Louise A</creator><creator>Newell, John</creator><creator>Dunne, Fidelma P.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20151101</creationdate><title>Feasibility, acceptability and uptake rates of gestational diabetes mellitus screening in primary care vs secondary care: findings from a randomised controlled mixed methods trial</title><author>Tierney, Marie ; O’Dea, Angela ; Danyliv, Andriy ; Glynn, Liam G. ; McGuire, Brian E. ; Carmody, Louise A ; Newell, John ; Dunne, Fidelma P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c485t-2b7b73ac9cd702ea542319aa00452ce9ad1df22a40f26eaf3927eb25b6f9b38d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Diabetes, Gestational - diagnosis</topic><topic>Female</topic><topic>Gestational diabetes</topic><topic>Glucose</topic><topic>Glucose Tolerance Test</topic><topic>Health Services Accessibility</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Ireland</topic><topic>Mass Screening</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Mixed methods research</topic><topic>Patient Acceptance of Health Care</topic><topic>Pregnancy</topic><topic>Primary care</topic><topic>Primary Health Care</topic><topic>Secondary Care</topic><topic>Womens health</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tierney, Marie</creatorcontrib><creatorcontrib>O’Dea, Angela</creatorcontrib><creatorcontrib>Danyliv, Andriy</creatorcontrib><creatorcontrib>Glynn, Liam G.</creatorcontrib><creatorcontrib>McGuire, Brian E.</creatorcontrib><creatorcontrib>Carmody, Louise A</creatorcontrib><creatorcontrib>Newell, John</creatorcontrib><creatorcontrib>Dunne, Fidelma P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>ProQuest - Health & Medical Complete保健、医学与药学数据库</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetologia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tierney, Marie</au><au>O’Dea, Angela</au><au>Danyliv, Andriy</au><au>Glynn, Liam G.</au><au>McGuire, Brian E.</au><au>Carmody, Louise A</au><au>Newell, John</au><au>Dunne, Fidelma P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Feasibility, acceptability and uptake rates of gestational diabetes mellitus screening in primary care vs secondary care: findings from a randomised controlled mixed methods trial</atitle><jtitle>Diabetologia</jtitle><stitle>Diabetologia</stitle><addtitle>Diabetologia</addtitle><date>2015-11-01</date><risdate>2015</risdate><volume>58</volume><issue>11</issue><spage>2486</spage><epage>2493</epage><pages>2486-2493</pages><issn>0012-186X</issn><eissn>1432-0428</eissn><abstract>Aims/hypothesis
It is postulated that uptake rates for gestational diabetes mellitus (GDM) screening would be improved if offered in a setting more accessible to the patient. The aim of this study was to evaluate the proportion of uptake of GDM screening in the primary vs secondary care setting, and to qualitatively explore the providers’ experiences of primary care screening provision.
Methods
This mixed methods study was composed of a quantitative unblinded parallel group randomised controlled trial and qualitative interview trial. The primary outcome was the proportion of uptake of screening in both the primary and secondary care settings. All pregnant women aged 18 years or over, with sufficient English and without a diagnosis or diabetes or GDM, who attended for their first antenatal appointment at one of three hospital sites along the Irish Atlantic seaboard were eligible for inclusion in this study. Seven hundred and eighty-one pregnant women were randomised using random permutated blocks to receive a 2 h 75 g OGTT in either a primary (
n
= 391) or secondary care (
n
= 390) setting. Semi-structured interviews were conducted with 13 primary care providers. Primary care providers who provided care to the population covered by the three hospital sites involved were eligible for inclusion.
Results
Statistically significant differences were found between the primary care (
n
= 391) and secondary care (
n
= 390) arms for uptake (52.7% vs 89.2%, respectively; effect size 36.5 percentage points, 95% CI 30.7, 42.4;
p
< 0.001), crossover (32.5% vs 2.3%, respectively;
p
< 0.001) and non-uptake (14.8% vs 8.5%, respectively;
p
= 0.005). There were no significant differences in uptake based on the presence of a practice nurse or the presence of multiple general practitioners in the primary care setting. There was evidence of significant relationship between probability of uptake of screening and age (
p
< 0.001). Primary care providers reported difficulties with the conduct of GDM screening, despite recognising that the community was the most appropriate location for screening.
Conclusions/interpretation
Currently, provision of GDM screening in primary care in Ireland, despite its acknowledged benefits, is unfeasible due to poor uptake rates, poor rates of primary care provider engagement and primary care provider concerns.
Trial registration
http://isrctn.org
ISRCTN02232125
Funding
This study was funded by the Health Research Board (ICE2011/03)</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26242644</pmid><doi>10.1007/s00125-015-3713-6</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0012-186X |
| ispartof | Diabetologia, 2015-11, Vol.58 (11), p.2486-2493 |
| issn | 0012-186X 1432-0428 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1718903580 |
| source | Springer Nature |
| subjects | Adult Diabetes, Gestational - diagnosis Female Gestational diabetes Glucose Glucose Tolerance Test Health Services Accessibility Human Physiology Humans Internal Medicine Ireland Mass Screening Medicine Medicine & Public Health Metabolic Diseases Mixed methods research Patient Acceptance of Health Care Pregnancy Primary care Primary Health Care Secondary Care Womens health Young Adult |
| title | Feasibility, acceptability and uptake rates of gestational diabetes mellitus screening in primary care vs secondary care: findings from a randomised controlled mixed methods trial |
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