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 |
Externí odkaz: |