Screening and Referral for Prediabetes in a Family Practice Clinic
Abstract
ABSTRACT
The purpose of this project was to implement a screening process for prediabetes (PD) in a family practice clinic and assess provider barriers to screening as well as patient preferences for participation in diabetes prevention programs (DPP). PD affects over a third of the U.S. population and most are unaware of their condition. Screening high risk individuals for PD and referring to DPPs is recommended by several national organizations, however screening rates are low and DPPS are underutilized. Utilizing the Prevent Diabetes STAT toolkit, 230 patients were assessed with the CDC prediabetes risk test. High risk patients were tested for PD with the fasting plasma glucose or A1C lab test. Of the 230 patients, 59.6% screened high risk on the CDC risk test and 26.1% had positive lab test for PD or a documented diagnosis. 17.5% self-reported a positive PD status. Almost half of those that screened high risk were tested with a lab test during the project period and 7.3% were not tested because of known positive PD status. There were 34 missed opportunities for lab testing in high risk patients due to “no action taken” (15.3%), “insufficient time” (7.3%), or “patient declined testing” (2.2%). A positive relationship was found between risk test score and FPG among those tested (P<0.001). No patients were referred to a DPP despite over half of those surveyed expressing interest. Potential barriers to participation included time constraints, location, and program cost. Only 11.1% of patients surveyed knew that DPPs are covered by insurance. Providers “Strongly Agreed” that screening for PD was important part of their practice and were “Neutral” for having insufficient time to address prediabetes. Provider responses demonstrated improved understanding of CDC recognized DPPs. Results support use of the CDC PD risk test in routine practice. DPP location and lack of awareness of insurance coverage likely play a role in DPP underutilization.
The purpose of this project was to implement a screening process for prediabetes (PD) in a family practice clinic and assess provider barriers to screening as well as patient preferences for participation in diabetes prevention programs (DPP). PD affects over a third of the U.S. population and most are unaware of their condition. Screening high risk individuals for PD and referring to DPPs is recommended by several national organizations, however screening rates are low and DPPS are underutilized. Utilizing the Prevent Diabetes STAT toolkit, 230 patients were assessed with the CDC prediabetes risk test. High risk patients were tested for PD with the fasting plasma glucose or A1C lab test. Of the 230 patients, 59.6% screened high risk on the CDC risk test and 26.1% had positive lab test for PD or a documented diagnosis. 17.5% self-reported a positive PD status. Almost half of those that screened high risk were tested with a lab test during the project period and 7.3% were not tested because of known positive PD status. There were 34 missed opportunities for lab testing in high risk patients due to “no action taken” (15.3%), “insufficient time” (7.3%), or “patient declined testing” (2.2%). A positive relationship was found between risk test score and FPG among those tested (P<0.001). No patients were referred to a DPP despite over half of those surveyed expressing interest. Potential barriers to participation included time constraints, location, and program cost. Only 11.1% of patients surveyed knew that DPPs are covered by insurance. Providers “Strongly Agreed” that screening for PD was important part of their practice and were “Neutral” for having insufficient time to address prediabetes. Provider responses demonstrated improved understanding of CDC recognized DPPs. Results support use of the CDC PD risk test in routine practice. DPP location and lack of awareness of insurance coverage likely play a role in DPP underutilization.