Year of Publication

2014

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Linda Alexander, EdD

Committee Member

Kate Eddens, PhD

Committee Member

Robin Vanderpool, DrPH, CHES

Abstract

Diabetes mellitus (DM) is an overwhelming health issue in the United States affecting 25.8 million people, which is equivalent to 8.3% of the population.1 It is the seventh leading cause of death and a major cause of serious complications such as heart disease, stroke, kidney failure, nontraumatic lower limb amputations, and new causes of blindness among adults in the U.S.1 Paralleling the obesity epidemic, the rates of DM incidence and prevalence continue to rise each year.2 One particularly troubling public health issue related to DM is that over a quarter of the people who have this disease are unaware, even though research has shown that preventative care can delay the onset of DM and its complications.1,3 In order to try to combat this problem, a Healthy People 2020 objective was established to increase the proportion of persons with diabetes whose condition had been diagnosed by 10%.4 Improving primary prevention among those at risk of developing DM and increasing early diagnosis could lead to significant savings in human and financial costs associated with this disease. While it is commonly understood that screening which enables early diagnosis of diabetes can allow for more effective management and appropriate treatment of the disease, low screening rates still remain a major public health issue.5 The American Diabetes Association (ADA) has issued guidelines about what patient populations should be screened and when, and have provided support for testing to be carried out within the health care setting; however, there remains a need for improvement in terms of effective methods to enhance the proportion of people who are actually being screened.6 As research studies continue to report the evidence for improving screening practices and the patients’ improved outcomes, specific populations for whom screening is particularly important have been identified. 3 Women with a history of gestational diabetes are a unique target population with critical diabetes screening needs. Previous research has shown that women who have had gestational diabetes have a 35% to 60% chance of developing diabetes in the next 10-20 years.1 Since these women are considered at high risk for developing diabetes, the ADA recommends that screening for the development of diabetes be performed every one to two years. However, at least one study showed that only 37% of women underwent the postpartum diabetes screening tests recommended by the ADA.7 Gestational diabetes is diagnosed when women who have never had diabetes before develop high glucose levels during pregnancy, which can lead to poor outcomes for the baby such as a high birth weight, delivery injuries, and increased risk of diabetes later in life for both the baby and the mother.8 Perceptions about health beliefs and lifestyle behaviors may be an important part of the equation for care for women with gestational diabetes. These perceptions include not only a women’s belief about their risk factors, but their experiences within the health care system itself. In ambulatory care settings, a comprehensive health care review includes a range of interactions with different providers including physicians, pharmacists, nutritionists, and nursing staff. Compliance with the directives of their healthcare providers, such as medication adherence, physical activity, and proper eating may be dependent upon women’s positive or negative experiences with care. 9,10 It is important that research be conducted to determine specific strategies to improve rates of screenings among people at high risk of developing diabetes, like women who have had gestational diabetes, so that they are able to receive quality care and prevent significant costs associated with the disease. 4 In this study, we sought to determine if women with a history of gestational diabetes were more likely to be screened and diagnosed with diabetes depending on their level of medical care and satisfaction with their patient/provider relationship. Previous research has shown that patient trust in his or her physician may positively influence patient adherence to diabetes management recommendations.11 However, one study found that while longer continuity of care was associated with greater patient satisfaction and confidence in one's physician, it was not associated with a greater likelihood of receiving recommended preventive services.12 Therefore, in order to make evidence-based recommendations about improving diabetes screening, more information is needed about whether satisfaction with the patient/provider relationship makes a difference in screening practices of patients and the prevalence of diabetes. The results of this study could emphasize the importance of preventative practices and expand the amount of evidence available to healthcare providers about increasing the amount of time invested in their patients in order to improve their patients’ satisfaction with their relationship and overall health outcomes.

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