scholarly journals Risks and Benefits of Screening for Dementia in Primary Care: The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of Dementia Screening (IU CHOICE)Trial

2019 ◽  
Vol 68 (3) ◽  
pp. 535-543 ◽  
Author(s):  
Nicole R. Fowler ◽  
Anthony J. Perkins ◽  
Sujuan Gao ◽  
Greg A. Sachs ◽  
Malaz A. Boustani
Keyword(s):  
Primary Care ◽  
Health Outcomes ◽  
Comparative Effectiveness ◽  
Choice Trial ◽  
Indiana University ◽  
Cognitive Health ◽  
Risks And Benefits ◽  
Dementia Screening

P2-279: COGNITIVE HEALTH OUTCOMES INVESTIGATION OF THE COMPARATIVE EFFECTIVENESS OF DEMENTIA SCREENING: THE INDIANA UNIVERSITY CHOICE STUDY

2014 ◽  
Vol 10 ◽  
pp. P579-P579
Author(s):  
Nicole R. Fowler ◽  
Amanda Harrawood ◽  
Amie Frame ◽  
Anthony Perkins ◽  
Sujuan Gao ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Comparative Effectiveness ◽  
Indiana University ◽  
Cognitive Health ◽  
University Choice ◽  
Dementia Screening

scholarly journals Older Primary Care Patients’ Attitudes and Willingness to Screen for Dementia

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Nicole R. Fowler ◽  
Anthony J. Perkins ◽  
Hilary A. Turchan ◽  
Amie Frame ◽  
Patrick Monahan ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Screening Instrument ◽  
Perceived Benefits ◽  
Risks And Benefits ◽  
Dementia Screening ◽  
Primary Care Patients ◽  
Telephone Screening ◽  
Screening Behaviors

Objective. To understand older primary care patients’ perceptions of the risks and benefits of dementia screening and to measure the association between attitudes and screening behaviors.Methods. Eligible patients completed the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) questionnaire and then were asked to undergo dementia screening by a telephone screening instrument.Results. Higher scores on the PRISM-PC questionnaire items that measure attitudes about benefits of screening were associated with decreased odds of refusing screening. Participants who refused screening had significantly lower PRISM-PC questionnaire scores on the items that measure perceived benefits compared to those who agreed to screening. Participants who refused screening were less likely to agree on screening for other conditions, such as depression and cancer. Participants who know someone with Alzheimer’s disease (AD) were less likely to refuse screening.Discussion. Patients’ attitudes about the benefits of dementia screening are associated with their acceptance of dementia screening.

Preventative health screening community events, a mechanism to target minority ethnic populations in improving primary care utilisation to improve health outcomes

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711005
Author(s):  
Raza Naqvi ◽  
Octavia Gale
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Outcomes ◽  
Ethnic Minority ◽  
Access To Health Care ◽  
Health Screening ◽  
Service Utilisation ◽  
Community Based ◽  
Access To Health ◽  
Minority Ethnic

BackgroundPreventative medicine has become a central focus in primary care provision, with greater emphasis on education and access to health care screening. The Department of Health reports existing health inequalities and inequalities in access within ethnic minority groups. Studies assessing the value of community engagement in primary care have reported variable outcomes in term of subsequent service utilisation.AimTo consider the benefit of community-based health screening checks to improve access and health outcomes in minority ethnic groups.MethodAn open community health screening event (n = 43), to allow targeted screening within an ethnic minority population. Screening included BP, BMI, BM and cholesterol. Results were interpreted by a healthcare professional and counselling was provided regarding relevant risk factors. Post-event feedback was gathered to collate participant opinion and views.ResultsSeventy-nine per cent of participants were from ethnic minority backgrounds: 64% were overweight or obese and 53% of participants were referred to primary care for urgent review following abnormal findings. All those referred would not have accessed healthcare without the event referral. All (100%) participants believed it improved health education and access to health care.ConclusionThis study clearly demonstrates the value of targeted community-led screening and education events in public health promotion. There was a significant benefit in providing community-based screening. There is a need for a longitudinal analysis to determine the impact on health outcomes and long-term access to healthcare provision.

scholarly journals Withdrawal of inhaled corticosteroids versus continuation of triple therapy in patients with COPD in real life: observational comparative effectiveness study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Helgo Magnussen ◽  
◽  
Sarah Lucas ◽  
Therese Lapperre ◽  
Jennifer K. Quint ◽  
...  
Keyword(s):  
Primary Care ◽  
Triple Therapy ◽  
Comparative Effectiveness ◽  
Inhaled Corticosteroids ◽  
Blood Eosinophil ◽  
Research Database ◽  
Effectiveness Study ◽  
Increased Risk ◽  
Comparative Effectiveness Study ◽  
Oral Corticosteroids

Abstract Background Inhaled corticosteroids (ICS) are indicated for prevention of exacerbations in patients with COPD, but they are frequently overprescribed. ICS withdrawal has been recommended by international guidelines in order to prevent side effects in patients in whom ICS are not indicated. Method Observational comparative effectiveness study aimed to evaluate the effect of ICS withdrawal versus continuation of triple therapy (TT) in COPD patients in primary care. Data were obtained from the Optimum Patient Care Research Database (OPCRD) in the UK. Results A total of 1046 patients who withdrew ICS were matched 1:4 by time on TT to 4184 patients who continued with TT. Up to 76.1% of the total population had 0 or 1 exacerbation the previous year. After controlling for confounders, patients who discontinued ICS did not have an increased risk of moderate or severe exacerbations (adjusted HR: 1.04, 95% confidence interval (CI) 0.94–1.15; p = 0.441). However, rates of exacerbations managed in primary care (incidence rate ratio (IRR) 1.33, 95% CI 1.10–1.60; p = 0.003) or in hospital (IRR 1.72, 95% CI 1.03–2.86; p = 0.036) were higher in the cessation group. Unsuccessful ICS withdrawal was significantly and independently associated with more frequent courses of oral corticosteroids the previous year and with a blood eosinophil count ≥ 300 cells/μL. Conclusions In this primary care population of patients with COPD, composed mostly of infrequent exacerbators, discontinuation of ICS from TT was not associated with an increased risk of exacerbation; however, the subgroup of patients with more frequent courses of oral corticosteroids and high blood eosinophil counts should not be withdrawn from ICS. Trial registration European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (EUPAS30851).

scholarly journals The Rapid Mood Screener: A Novel and Pragmatic Screener Tool for Bipolar I Disorder

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 167-168
Author(s):  
C. Brendan Montano ◽  
Mehul Patel ◽  
Rakesh Jain ◽  
Prakash S. Masand ◽  
Amanda Harrington ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Health Outcomes ◽  
Screening Tool ◽  
Clinical Interview ◽  
Clinical Practices ◽  
Predictive Values ◽  
Bipolar I Disorder ◽  
Manic Symptoms ◽  
Depressive Episodes

AbstractIntroductionApproximately 70% of patients with bipolar disorder (BPD) are initially misdiagnosed, resulting in significantly delayed diagnosis of 7–10 years on average. Misdiagnosis and diagnostic delay adversely affect health outcomes and lead to the use of inappropriate treatments. As depressive episodes and symptoms are the predominant symptom presentation in BPD, misdiagnosis as major depressive disorder (MDD) is common. Self-rated screening instruments for BPD exist but their length and reliance on past manic symptoms are barriers to implementation, especially in primary care settings where many of these patients initially present. We developed a brief, pragmatic bipolar I disorder (BPD-I) screening tool that not only screens for manic symptoms but also includes risk factors for BPD-I (eg, age of depression onset) to help clinicians reduce the misdiagnosis of BPD-I as MDD.MethodsExisting questionnaires and risk factors were identified through a targeted literature search; a multidisciplinary panel of experts participated in 2 modified Delphi panels to select concepts thought to differentiate BPD-I from MDD. Individuals with self-reported BPD-I or MDD participated in cognitive debriefing interviews (N=12) to test and refine item wording. A multisite, cross-sectional, observational study was conducted to evaluate the screening tool’s predictive validity. Participants with clinical interview-confirmed diagnoses of BPD-I or MDD completed a draft 10-item screening tool and additional questionnaires/questions. Different combinations of item sets with various item permutations (eg, number of depressive episodes, age of onset) were simultaneously tested. The final combination of items and thresholds was selected based on multiple considerations including clinical validity, optimization of sensitivity and specificity, and pragmatism.ResultsA total of 160 clinical interviews were conducted; 139 patients had clinical interview-confirmed BPD-I (n=67) or MDD (n=72). The screening tool was reduced from 10 to 6 items based on item-level analysis. When 4 items or more were endorsed (yes) in this analysis sample, the sensitivity of this tool for identifying patients with BPD-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. These properties represent an improvement over the Mood Disorder Questionnaire, while using >50% fewer items.ConclusionThis new 6-item BPD-I screening tool serves to differentiate BPD-I from MDD in patients with depressive symptoms. Use of this tool can provide real-world guidance to primary care practitioners on whether more comprehensive assessment for BPD-I is warranted. Use of a brief and valid tool provides an opportunity to reduce misdiagnosis, improve treatment selection, and enhance health outcomes in busy clinical practices.FundingAbbVie Inc.

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