How to improve opportunistic screening by using EMRs and other data. The prevalence of undetected diabetes mellitus in target population in Croatia

Autor: Linda Carkaxhiu, Ines Zelić, Iva Botica, I. Pavlić Renar, Josipa Kern, M. Vrca Botica, D. Iliev, A. Vrca
Rok vydání: 2016
Předmět:
Adult
Male
Pediatrics
medicine.medical_specialty
endocrine system diseases
Croatia
Population
030209 endocrinology & metabolism
Target population
Type 2 diabetes
Overweight
Prediabetic State
03 medical and health sciences
0302 clinical medicine
General Practitioners
Risk Factors
Diabetes mellitus
Outcome Assessment
Health Care
medicine
Odds Ratio
Prevalence
Electronic Health Records
Humans
Mass Screening
030212 general & internal medicine
Prospective Studies
education
Opportunistic screening
Aged
education.field_of_study
Health Services Needs and Demand
Primary Health Care
business.industry
Public Health
Environmental and Occupational Health
nutritional and metabolic diseases
General Medicine
Odds ratio
Middle Aged
medicine.disease
Confidence interval
Surgery
Diabetes Mellitus
Type 2
Regression Analysis
Female
medicine.symptom
business
Zdroj: Public health. 145
ISSN: 1476-5616
Popis: Opportunistic screening for type 2 diabetes (T2D) has not been adopted as part of routine practice. The aim of the study was to investigate the yield of opportunistic target screening for T2D in Croatia and to evaluate the process of screening by using data from electronic medical record.We conducted opportunistic screening in 23 general practitioners (GPs) in a population of 13,344 patients aged 45-70 years.First, after excluding patients with T2D, patients with risk factors for T2D were derived from the electronic medical record and GP's assessment during the preconsultation phase. Second, those with data about normoglycemia in past three years were excluded. Remaining patients started the consultation phase during their usual visit, when they were offered capillary fasting plasma glucose testing in the next consultation.Prevalence of T2D was 10.9% (new 1.4%). A total of 5568 (46.1%) patients had risks and 2849 (51.2%) had data about normoglycemia in the last three years. Using those data, number needed to invite to screening (NNI) was reduced to half: from 46.1% to 22.5%. One hundred eighty-four patients were screened positive for T2D in two capillary fasting plasma glucose tests (yield 9.8%). Number needed to screen (NNS) in order to detect one T2D was 10.3 patients. Among risks for T2D, overweight was the best predictive factor for undiagnosed T2D (odds ratio [OR]: 2.11, confidence interval [CI]:1.41-3.15, P .001). Logistic regression showed that in targeted population, overweight patients with a family history in fold were 2.5 times more likely to have T2D (OR: 2.54, CI 1.78-.61, P .001).Total yield in targeted population was 1,4%. By using data about normoglycemia from EMRs, NNI was reduced by half and NNS was 10.3 patients. Our findings suggest the model for improvement in opportunistic screening.
Databáze: OpenAIRE
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