Did the 2015 USPSTF Abnormal Blood Glucose Recommendations Change Clinician Attitudes or Behaviors? A Mixed-Method Assessment

Abstract

Background

In 2015, the US Preventive Services Task Force (USPSTF) revised clinical recommendations to more broadly recommend abnormal blood glucose screening and more clearly recommend referral to behavioral interventions for adults with prediabetes.

Objective

To assess the effects of the 2015 USPSTF recommendation changes on abnormal blood glucose screening and referral to behavioral interventions, and to examine physicians’ perceptions of the revised recommendation.

Design

We utilized a sequential, dependent mixed-methods triangulation design.

Participants

A total of 33,444 patients meeting USPSTF abnormal blood glucose screening criteria within 15 health system–affiliated primary care practices and 20 primary care physicians in North Carolina.

Main Measures

We assessed monthly abnormal blood glucose screening rate and monthly referral rate to behavioral interventions. To estimate trend changes in outcomes, we used segmented linear regression analysis of interrupted time-series data. We gathered physicians’ perspectives on the 2015 USPSTF abnormal blood glucose recommendation including awareness of, agreement with, adoption of, and adherence to the recommendation. To analyze qualitative data, we used directed content analysis.

Key Results

There was a slight significant change in trend in abnormal blood glucose screening rates post-recommendation. There was a slight, statistically significant decrease in referral rates to behavioral interventions post-recommendation. Physicians were generally unaware of the revisions to the 2015 USPSTF abnormal blood glucose recommendation; however, once the recommendations were described, physicians agreed with the screening recommendation but felt that the behavioral intervention referral recommendation was hard to implement.

Conclusion

The 2015 USPSTF abnormal blood glucose guideline had little to no effect on abnormal blood glucose screening or referral to behavioral interventions in North Carolina practices. Potential interventions to improve these rates could include clinical decision tools embedded in the electronic health record and better referral systems for community-based diabetes prevention programs.

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Funding

This research was funded by the Agency for Healthcare Quality and Research, Grant No. 1 R36 HS025561-01A1 (Thomas).

This research was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR002489.

This research was also partially supported by a National Research Service Award Pre-Doctoral Traineeship (Thomas) and Post-Doctoral Fellowship (Kinlaw) from the Agency for Healthcare Research and Quality sponsored by the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Grant No. 5T32 HS000032-28.

Dr. Thomas received funding from The Permanente Medical Group (TPMG) Delivery Science Fellowship Program and the National Institute of Diabetes and Digestive and Kidney Diseases grant T32DK11668401.

Dr. Golin’s salary was partially supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (5K24HD069204).

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Correspondence to Tainayah W. Thomas PhD, MPH.

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Conflict of Interest

Dr. Thomas reports grants from the Agency for Healthcare Research and Quality, grants from the National Institute of Diabetes and Digestive and Kidney Diseases, and grants from the National Center for Advancing Translational Sciences, during the conduct of the study.

Dr. Golin reports grants from the Agency for Healthcare Research and Quality, during the conduct of the study; personal fees from iRT (innovation, Research, and Training, Inc.); and personal fees from UAMS ARCH-D Health Disparities Center, outside the submitted work.

Dr. Kinlaw reports grants from the Agency for Healthcare Research and Quality and grants from the National Center for Advancing Translational Sciences, during the conduct of the study.

Dr. Kirkman reports grans from Novo Nordisk, Bayer, outside the submitted work.

Dr. Golden has nothing to disclose.

Dr. Samuel-Hodge has nothing to disclose.

Dr. Lightfoot reports grants from the Agency for Healthcare Research and Quality and grants from the National Center for Advancing Translational Sciences, during the conduct of the study.

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Thomas, T.W., Golin, C.E., Kinlaw, A.C. et al. Did the 2015 USPSTF Abnormal Blood Glucose Recommendations Change Clinician Attitudes or Behaviors? A Mixed-Method Assessment. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-021-06749-x

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KEY WORDS

  • diabetes prevention
  • clinical guidelines
  • prediabetes
  • USPSTF