Increase Screening Rates Research Articles

Inclusive healthcare for persons with disabilities (PWDs) in advocacy and partnership in breast and cervical cancer screening through the EMPOWER Program.

e22510 Background: With the growing burden of Women cancers in Kenya, integrating cancer screening and prevention to optimize horizontal care delivery models is a paramount approach to strengthening women-centered and cost-effective primary healthcare. EMPOWER is a unique public-private-partnership with the County governments of Kenya, County referral hospitals, County First Ladies Association, International Cancer Institute, Patient organizations (Women4Cancer & Africa cancer Foundation), AMREF and Roche Kenya to demonstrate and deliver integrated cancer prevention, treatment and capacity building including Persons living with Disability (PWDs). Objectives: 1. Generate buy in from county leadership and key stakeholders for PWDs inclusivity in human resources for health. 2. Tangibly demonstrate women PWDs can contribute to community health systems community health volunteers and Promote the Integrated approach screening. 3. Improve access to breast and cervical cancer screening for and through PWDs. Methods: The Project is a multi-faceted advocacy approach, including political leadership engagement and stakeholder alignment. The political leadership engaged with local government officials to raise awareness of the issue and secure support for the initiative. The stakeholder alignment involved working with healthcare providers, community organizations, and PWDs to ensure that the initiative was inclusive and accessible. Qualitative and quantitative methods were used to evaluate the impact of the advocacy efforts. Results: The project was successful in health management teams co-creating selecting and training 50 Women PWDs as community health volunteers, the first in Africa. The advocacy efforts led to an increase in screening rates for PWDs, with 30% more PWDs accessing screening services compared to the previous year. The PWDs involved in the initiative reported high levels of satisfaction with the program and appreciated the opportunity to play an active role in their own healthcare. Conclusions: The project demonstrated that it is possible to effectively implement inclusive healthcare for persons with disabilities (PWDs) through advocacy and partnerships. The successful adoption of advocacy to address disparities in breast and cervical cancer screening among PWDs highlights the potential for scaling up this work to reach a larger population. The alignment of political leadership and stakeholders, highlights the crucial role of creating a supportive environment to ensure the rights of PWDs to the highest attainable standard of health are upheld. Future efforts to address health disparities among PWDs should build on this approach, leveraging advocacy, partnerships, and cocreation of implementation to drive change at the community level.

Breast Cancer Champions: a peer-to-peer education and mobile mammography program improving breast cancer screening rates for women of African heritage.

Nationally, women of African heritage die at higher rates from breast cancer than women of other races or ethnicities. We developed Breast Cancer Champions (BCC) a peer-to-peer education program, which recruited 12 women and deployed them into the community in August 2020 during the height of the COVID pandemic. BCC aims to improve breast cancer screening rates for women of African heritage through peer-to-peer education, which has proven successful for addressing cancer-related health disparities. BCC community experts, or "Champions," are peer-to-peer educators that conduct awareness and screening events in their communities. Champion's education activities were tracked by bi-weekly check-in calls, which recorded the activity type, location, and the number of participants for each event. We used spatial and statistical analyses to determine the efficacy of the program at increasing screening rates for women within the area of Champion activity versus women outside of their activity area. Over 15months, Champions conducted 245 in-person or online events to engage women in their community for screening. More women of African heritage were screened in areas Champions were active during the intervention compared to historical data comparing areas outside of the Champion activity in the prior 15months (X 2 = 3.0845, p = 0.079). BCC successes could be attributed to pivoting to online community building when in-person events were restricted and enabling Champions to design and conduct their own events, which increased outreach possibilities. We demonstrate improved screening outcomes associated with an updated peer-to-peer education program.

Impact of distance to treatment center on tumor stage of nasopharyngeal cancer at presentation.

Impact of distance to treatment center on tumor stage of nasopharyngeal cancer at presentation.

Addressing gaps in osteoporosis screening in kuwait using opportunistic quantitative computer tomography (QCT): a retrospective study

To demonstrate the feasibility and clinical utility of opportunistic osteoporosis screening in Kuwait using QCT, aiming to increase screening rates in a country with a relatively high prevalence of osteoporosis and an alarming trend of increasing incidence of fractures. At a tertiary referral center, all abdominal CT scans performed on females ≥60 years old between 12/2020 and 12/2021 were retrospectively utilized for asynchronous QCT acquisition. The average volumetric bone mineral density (vBMD) was calculated, and rates of osteoporosis (vBMD < 80 mg/cm3 calcium hydroxyapatite) and osteopenia (80-120 mg/cm3) were determined. CT images were reviewed to assess for the presence of vertebral fractures. For each patient, the electronic health record was reviewed for any previous DXA scans. vBMD was calculated in 305 females ≥60 years old (mean [SD] 71 [8.7], range 60-93). Low bone mass was detected in 258 patients (84.6%); 148 (48.5%) met criteria for osteopenia and 110 (36.1%) for osteoporosis. Osteoporotic vertebral fractures were observed in 64 (21.0%) study participants. Only 73 patients (23.9% of total) had a previous DXA documented in the reviewed health records. For 231 patients who were ≥65 years old, who would routinely qualify for a screening DXA, only 63 (27.3%) had a documented DXA available. vBMD measurements obtained by opportunistic QCT had comparable rates of osteopenia and osteoporosis detection to those previously reported using DXA in a similar population in Kuwait. These findings suggest that opportunistic QCT on preexisting CT scans can be effectively utilized to narrow gaps in osteoporosis screening.

An electronic medical record (EMR) prompt improves screening rates for metabolic conditions among children with obesity.

This study evaluated the effectiveness of an automated prompt in the electronic medical record (EMR) to increase screening rates for metabolic conditions and referrals to health education and to improve BMI percentile among children with obesity. The intervention used an EMR reminder that provided a panel of lab orders (hemoglobin A1c, lipid panel, and alanine aminotransferase) during clinical encounters among pediatric patients ages 10 to 18 with BMI ≥ 95th percentile. Data on demographics, comorbid conditions, BMI, lab results, and health education referrals were analyzed. Cohorts during the year before (n= 3479) and after (n= 3439) workflow implementation were compared. The distribution of race/ethnicity among children with obesity was 56% Hispanic, 19% White, 11% Filipino, 4% Pacific Islander, 3% Black, and 1% East/South Asian. Orders for metabolic lab tests increased from 2% in the pre-workflow period to 52% in the post-workflow period (p< 0.0001). Completed screening rates improved from 1% to 27% (p< 0.0001). Health education referrals increased from 0.4% to 7% (p< 0.0001). We observed a mean change in BMI percentile of -0.13% (p= 0.06). This study validates the use of an EMR-based prompt to improve metabolic lab screening and health education referrals among children with obesity. During the limited period of follow-up, we found no significant change in BMI percentile.

Examining changes in knowledge and practice in nurse practitioners after an online educational module on obstructive sleep apnea

AimsThe purpose of this study is to investigate primary care nurse practitioner (NP) knowledge and knowledge retention on obstructive sleep apnea (OSA) screening after an educational in-service. BackgroundThe prevalence of OSA is high and continues to rise amid the obesity epidemic. Approximately 75–90 % of individuals with moderate to severe OSA remain undiagnosed. Continuing education of OSA risk factors among primary care providers may increase screening rates, leading to early diagnosis and treatment. MethodsAn educational module was presented to NPs (n = 30) during a mandatory NP in-service at two sets of outpatient clinics. Knowledge was assessed with a pre-test and post-test survey consisting of 23 items. A 25-item follow-up test was administered five weeks after to assess knowledge retention. ResultsAn increase in total knowledge scores was demonstrated between the pre-test and post-test with a decrease in knowledge observed at follow-up. Follow-up test total mean scores remained above pre-test levels, indicating potential long-term learning. ConclusionsWhile learning was demonstrated, NPs acknowledged continued barriers to screening for OSA such as time and having no OSA screening tool available in the electronic medical record (EMR).

Economic Evaluation of Mailed Home-Based Human Papillomavirus Self-sampling Kits for Cervical Cancer Screening

Human papillomavirus (HPV) self-sampling addresses barriers to cervical cancer screening, and mailed self-sampling kits have been reported to increase screening uptake. International research suggests mailed kits are cost-effective in certain settings. However, the cost-effectiveness of mailing HPV self-sampling kits for increasing screening uptake has not been evaluated in the US. To conduct an economic evaluation of a mailed HPV self-sampling intervention among underscreened women enrolled in an integrated US health care system. This economic evaluation involved a cost-effectiveness analysis of results from a randomized clinical trial of 19 851 women aged 30 to 64 years enrolled in a health plan from Kaiser Permanente Washington (KPWA), a US-based integrated health care system. Women were identified through electronic medical records, and eligible participants were enrolled in a health plan for at least 3 years and 5 months, had a primary care clinician, had not received a Papanicolaou test for at least 3 years and 5 months, and had not received a hysterectomy. Enrollment occurred from February 25, 2014, to August 29, 2016, with follow-up through February 25, 2018. The current economic evaluation was conducted between August 2, 2021, and July 30, 2022. Intervention delivery costs were calculated from both the KPWA and Medicare perspectives and were based on either wellness visit or Papanicolaou test-only visit costs. Participants in the control group received usual care, which comprised patient reminders and ad hoc outreach for screening. Participants in the intervention group received usual care plus a mailed HPV self-sampling kit. The primary economic outcome was the incremental cost-effectiveness ratio (ICER) for increased screening uptake, defined as the incremental difference in cost (intervention group minus control group) divided by the difference in the number of participants completing screening (intervention group minus control group) within 6 months of randomization. Among 19 851 women (mean [SD] age, 50.1 [9.5] years; 76.7% White), 9960 were randomized to the intervention group, and 9891 were randomized to the control group. Baseline ICERs ranged from $85.84 (95% CI, $85.68-$85.99) using KPWA wellness visits as the cost basis to $146.29 (95% CI, $146.20-$146.38) using Medicare Papanicolaou test-only visits as the cost source. Subgroups of participants aged 50 to 64 years and participants most recently overdue for screening achieved cost-effectiveness at lower levels of willingness to pay for an additional completed screening than other subgroups. In this economic evaluation, mailing HPV self-sampling kits to women overdue for cervical cancer screening was cost-effective for increased screening uptake relative to usual care. These results support mailing HPV kits as an efficient outreach strategy for increasing screening rates among eligible women in US health care systems.

Service Accessibility as a Determinant of Cervical Cancer Screening in Gwanda District, Zimbabwe

Zimbabwe has one of the highest prevalence of cervical cancers in the world. The country has a low screening coverage despite the availability of cost-effective and evidence-based interventions for the prevention of the disease that include screening. This study therefore assessed service accessibility as a determinant of screening in Gwanda District, Zimbabwe. An explanatory sequential mixed-method design was employed firstly using a quantitative survey of 609 screening-eligible women selected through multi-stage random sampling. Subsequently, 36 women purposely selected from the quantitative phase were engaged in focus group discussions, and 25 health-care workers as key informants. About 74.4% of rural participants had never been screened compared to 62.1% of urban participants. Qualitative findings revealed that the district has two screening sites, both in urban locations. Rural based women access the service through outreach clinics which are inconsistent with no provision for treatment. Furthermore, treatment facilities are centralised to the provincial hospital at a fee. Financial constraints associated with travel expenses and treatment costs emerged as the key factor that hinders participation in screening. Improved access to services could greatly increase screening rates to match the high demand in the district. Decentralising screening to primary health facilities could ensure ready access of the service and enhance screening. Supplemental to that, outreach services to hard to reach areas need to be increased and sustained.

Hepatitis B virus screening in Asian immigrants: Community-based campaign to increase screening and linkage to care: A cross-sectional study.

Despite established screening guidelines, many Asian immigrants remain unscreened. Furthermore, those with chronic hepatitis B(CHB) are not linked to care citing multiple barriers. The objective of this study was to determine the role of our community-based hepatitis B virus (HBV) campaign on HBV screening and the success of linkage to care (LTC) efforts. Asian immigrants from the New Jersey and New York metropolitan areas were screened for HBVfrom 2009 to 2019. We started to collect LTC data starting in 2015, and those found to be positive were followed up. In 2017, because of low LTC rates, nurse navigators were hired to aid in the LTC process. Those excluded from the LTC process included those who were already linked to care, declined, and/or had moved or passed away. Total of 13,566 participants were screened from 2009 to 2019, of which, the results for 13,466 were available. Of these, 372 (2.7%) were found to have positive HBV status. Approximately 49.3% were female and 50.1% were male, and the rest were of unknown gender. A total of 1191 (10.0%) participants were found to be HBV negative but required vaccination. When we started to track LTC, we found 195 participants that were eligible for LTC between 2015 and 2017 after the exclusion criteria were applied. It was found that only 33.8% were successfully linked to care in that time period. After hiring nurse navigators, we saw LTC rates increase to 85.7% in 2018 and to 89.7% in 2019. HBV community screening initiatives are imperative to increase screening rates in the Asian immigrant population. We were also able to demonstrate that nurse navigators can successfully help increase LTC rates. Our HBV community screening model can address issues with barriers to care including lack of access in comparable populations.

Screening behaviours, demographics, and stage at diagnosis in the publicly funded Ontario Breast Screening Program

PurposeThe Ontario Breast Screening Program (OBSP) offers free screening mammograms every 2 years, to women aged 50–74. Study objectives were to determine demographic characteristics associated with the adherence to OBSP and if women screened in the OBSP have a lower stage at diagnosis than non-screened eligible women.MethodsWe used the Ontario cancer registry (OCR) to identify 48,927 women, aged 51–74 years, diagnosed with breast cancer between 2010 and 2017. These women were assigned as having undergone adherent screening (N = 26,108), non-adherent screening (N = 6546) or not-screened (N = 16,273) in the OBSP. We used multinomial logistic regression to investigate the demographic characteristics associated with screening behaviour, as well as the association between screening status and stage at diagnosis.ResultsAmong women with breast cancer, those living in rural areas (versus the largest urban areas) had a lower odds of not being screened (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.68, 0.78). Women in low-income (versus high-income) communities were more likely not to be screened (OR 1.42, 95% CI 1.33, 1.51). When stratified, the association between income and screening status only held in urban areas. Non-screened women were more likely to be diagnosed with stage II (OR 1.91, 95% CI 1.82, 2.01), III (OR 2.96, 95% CI 2.76, 3.17), or IV (OR 8.96, 95% CI 7.94, 10.12) disease compared to stage I and were less likely to be diagnosed with ductal carcinoma in situ (DCIS) (OR 0.91, 95% CI 0.84–0.98).ConclusionsThis study suggests that targeting OBSP recruitment efforts to lower income urban communities could increase screening rates. OBSP adherent women were more likely to be diagnosed with earlier stage disease, supporting the value of this initiative and those like it.

An Electronic Medical Record Intervention to Increase Early Screening Rates for Gestational Diabetes.

Our objective was to implement an electronic medical record reminder to perform the early gestational diabetes mellitus (GDM) screening test and to evaluate if this intervention increased screening rates. We performed a retrospective chart review of all deliveries at Mount Sinai West in January 2020 to determine the number of patients that met criteria for and actually underwent early GDM screening. A total of 314 patients had complete charts with pregnancy data. The following American College of Obstetricians and Gynecologists (ACOG)-defined risk factors were collected: body mass index greater than 25 (Asians greater than 23), history of GDM, history of macrosomia, hypertension (systolic >140 or diastolic >90), polycystic ovarian syndrome, hemoglobin A1c above 5.7, cardiovascular disease, and family history of diabetes. We used this data to advocate for and design an electronic medical record-based intervention to remind obstetric providers to complete the early glucose challenge test screening for eligible patients at the first prenatal visit. Our investigation confirms there is a low adherence rate of 12% at our facility to ACOG's updated early GDM screening guidelines (12 out of 97 patients). Furthermore, nearly one-fifth (16 out of 85) of eligible patients who did not receive screening were eventually diagnosed with GDM by screening at 24 to 28 weeks. After implementing an electronic medical record reminder at the initial prenatal visit, screening rates more than doubled to 28% (33 out of 115 eligible patients). The most common diabetic risk factors were high-risk ethnic background, current hypertension, family history of diabetes, history of polycystic ovarian syndrome, and body mass index of 40 or greater. Our data suggests that obstetricians could be missing an opportunity to improve maternal and neonatal outcomes by diagnosing GDM earlier in pregnancy, as recommended by ACOG. The adoption of an electronic medical record reminder seems to improve the rate of indicated early GDM screening. · There is a low adherence rate of 16% to ACOG's updated early GDM screening guidelines.. · After implementing an electronic medical record alert at the initial prenatal visit, screening rates nearly doubled.. · Screening rates were higher at prenatal practices with resident physician involvement in patient care..

A three-year audit of the effectiveness of family physician reminders on cervical screening uptake amongst non-responders in a UK family medicine setting

Background: Cervical cancer screening is offered to all women in the United Kingdom (UK) between the ages of 24.5 and 64 years of age. The majority of screening is performed in primary care settings and the coverage rate remains stubbornly below 80%, despite an automated national invitation system. Objective: To audit the effectiveness of physician reminders during patient-booked telephone or face-to-face family medicine appointments upon non-responders to automated invitations. Methods: One physician in a primary healthcare centre opportunistically administered a three-step verbal invitation to all individuals identified as non-responders during their appointments with him. Patients seen face-to-face were also given a fourth invitation, a written slip to give to the receptionist to help them book an appointment. A code was entered into the patient’s notes to indicate that this patient had received the invitation. The invitation was continued for three years. The rate of screening uptake in the invitation arm was then compared to the rest of the non-responder population who received other non-structured reminders. Results: 122 patients in the invitation arm and 602 in the control arm met the inclusion criteria. Cervical screening uptake was 11.1% greater in the invitation arm than the control arm (p &lt; 0.0001; RR 1.188: CI 1.04 to 1.36). Patients receiving the fourth invitation in face-to-face appointments booked screening appointments 60 days earlier (mean = 110.8 days, n = 66) than those who received the verbal invitation only (mean = 170.4 days, n = 19, p = 0.08). Conclusion: There is evidence to support the use of both a verbal invitation followed by a written invitation by physicians in a family medicine setting in the UK for patients who are non-responders to cervical screening to increase uptake. The cost per extra cervical screening accepted in this non-responder population is £14.35. Both of these factors support the use of physician invitations to increase screening rates. Keywords cervical cancer screening, primary health care, non-responder, increasing uptake, invitations

Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening

IntroductionRural versus urban disparities have been observed in diabetic eye screening, but whether the level of disadvantage in rural versus urban areas is related to these disparities is unclear. Our...

HPV self-collection: what are we waiting for? Exploration of attitudes from frontline healthcare providers

ObjectivePolymerase chain reaction based human papilloma virus (HPV) self-collection for cervical cancer screening is well established. It is utilized worldwide, accepted by patients, is cost-effective, has comparable sensitivity to provider-collected...

Perspectives on Self-Sampling for Cancer Screening From Staff at Federally Qualified Health Centers in Rural and Segregated Counties: A Preliminary Qualitative Study.

Self-sampling for colorectal and cervical cancer screening can address the observed geographic disparities in cancer burden by alleviating barriers to screening participation, such as access to primary care. This preliminary study examines qualitative themes regarding cervical and colorectal cancer self-sampling screening tools among federally qualified health center clinical and administrative staff in underserved communities. In-depth interviews were conducted with clinical or administrative employees (≥18years of age) from FQHCs in rural and racially segregated counties in Pennsylvania. Data were managed and analyzed using QSR NVivo 12. Content analysis was used to identify themes about attitudes towards self-sampling for cancer screening. Eight interviews were conducted. Average participant age was 42years old and 88% of participants were female. Participants indicated that a shared advantage for both colorectal and cervical cancer self-sampling tests was their potential to increase screening rates by simplifying the screening process and offering an alternative to those who decline traditional screening. A shared disadvantage to self-sampling was the potential for inaccurate sample collection, either through the test itself or the sample collection by the patient. Self-sampling offers a promising solution to increase cervical and colorectal cancer screening in rural and racially segregated communities. This study's findings can guide future research and interventions which integrate self-sampling screening into routine primary care practice.

Strategies to address barriers and improve bowel cancer screening participation in Indigenous populations, particularly in rural and remote communities: A scoping review.

Participation in bowel cancer screening programs is low in Indigenous1 Australian populations, particularly in rural and remote communities. There is growing evidence of strategies to increase screening rates amongst Indigenous Australians, however, there are limited strategies specific to rural and remote communities. This review aims to identify strategies that may increase bowel cancer screening rates amongst Indigenous populations, particularly in rural and remote communities. A literature search was undertaken which included peer-reviewed qualitative and quantitative articles of any study design, and grey literature. Evidence from New Zealand, Canada, United Kingdom, and Australia were included, and descriptive numerical and thematic analyses were conducted. The identified strategies were categorised using the National Cancer Policy Board's organisational framework. Nineteen strategies were identified from 23 included articles. The most frequently used strategies were recommendation from a general practitioner, culturally appropriate education resources, and nonresponder follow up. Four strategies were specific to rural and remote communities including alternative distribution of kits and mobile screening. Thirteen strategies aim to address the Knowledge category of the framework, four address Attitudes, four address Ability, and six address Reinforcement. So What?: Several strategies are available to increase bowel cancer screening in Indigenous populations, with very few strategies specifically relating to rural and remote communities. Multiple strategies may maximise the likelihood of participation in screening amongst Indigenous Australians. Implementation may require system-level and local-level changes.

Task Sharing for Managing Common Noncommunicable Disease in a Nurse Led Noncommunicable Diseases Clinic in Peri-Urban Community of Chandigarh.

Nurse led noncommunicable diseases (NCD) clinic may address the significant shortage of human resource for health for managing common NCDs. The objective of this study is to assess the feasibility and effectiveness of nurse-led NCD clinic for identification, prevention, and management of common NCDs. A quasi experimental study was conducted at a Public Health Dispensary in periurban community of Northern India. Situational analysis and stakeholders' interview were done based on which the clinic was setup and run over a period of 2 months by registered nurses and nursing students to offer screening, health education and appropriate referral. The primary outcome of study was proportion of population screened, prevalence of common NCDs, risk factors modification, medication adherence, and patient satisfaction. It was feasible to run a nurse led clinic in terms of availability of space, equipment to run the clinic and human resource. A total of 455 individuals aged ≥30 years were enrolled using the total enumeration sampling technique. There was a significant increase in screening rates from 0.29% to 3.7% in nurse-led NCD clinic. There was significant mean change in systolic blood pressure (18.75 ± 6.92 mm Hg), diastolic blood pressure (4.4 ± 3.71 mm Hg), random blood sugar (33.36 ± 38.49 mg/dl) Body Mass Index, and waist circumference (P < 0.01) among the population screened. Medication adherence significantly increased from 7.8% to 76.4% (P < 0.01) after 2 months of nurse-led NCD clinic. Task sharing for managing common NCDs in nurse-led NCD clinic was feasible and effective in increasing screening rates, medication adherence, and risk factors modification among studied population.

Hepatitis B screening to reduce the risk of viral reactivation in gynecologic oncology patients receiving chemotherapy at a regional tertiary cancer center: A quality improvement initiative.

332 Background: In 2020, ASCO released a Provisional Clinical Opinion recommending universal hepatitis B virus (HBV) screening prior to systemic chemotherapy to reduce the risk of reactivation and associated morbidities. There is limited data for HBV prevalence and risk factors in gynecologic oncology. In gynecologic oncology patients at the Juravinski Cancer Centre, median baseline screening rate over 6 months was 0%. Our aim was to increase the rate of HBV screening to 70% in gynecologic oncology patients initiating chemotherapy over 6 months and compare real-world efficacy of risk factor-based vs. universal screening. Methods: We performed an interrupted time series study using the Model for Improvement methodology. Four interventions were introduced to address identified screening barriers: provider education, standardization of a testing protocol, integration with existing clinical workflow, and biweekly feedback reports. These were modified in response to outcomes and stakeholder feedback in Plan-Do-Study-Act cycles. Process and outcome measures data were collected by chart review and analyzed on statistical process control and run charts. Retrospective chart review collected demographic and disease data including Centers for Disease Control (CDC) hepatitis risk factors. Results: From Dec 1/20 to Nov 30/21, there were 381 new chemotherapy initiations in gynecology patients. The proportion of physicians screening increased significantly from 0% to 85%, and HBV monthly screening rates increased significantly from 0% to 72.2% by month 8 and were sustained for 4 months at last analysis. The integrated clinic screening protocol and feedback report interventions were each associated with increased screening rates. Of 330 unique patients initiating chemotherapy, 175 were screened (53%). Although ≥95% lacked data for 4 CDC hepatitis risk factors, 60.9% had ≥1 risk factor, and 11.2% had ≥2. HBV surface antigen (HBSAg) was non-reactive in all screened patients, but anti-HBV core (HBc) antibody was reactive in 5 (2.9%), indicative of prior infection. Real world risk factor-based screening in those with ≥1 CDC risk factor would have only identified 3/5 seropositive patients. In the screened population, risk-factor based screening had sensitivity 60%, specificity 38.8%, PPV 2.8%, NPV 97.1%. There were no HBV reactivations. Conclusions: Implementation of 4 interventions to increase HBV screening in gynecologic oncology patients receiving chemotherapy significantly improved screening rates, achieving our target at 8 months with sustained improvement. Risk-factor based screening lacks sensitivity compared to universal screening which may impact management. Lessons learned from this initiative may be applicable to other interventions to reduce infectious morbidity in oncologic populations.

Pediatric Subspecialist Alcohol Screening Rates and Concerns About Alcohol and Cannabis Use Among Their Adolescent Patients

PurposePediatric specialty care provides an opportunity to screen for and address patient substance use; however, little is known about providers’ screening rates, their opinions regarding substance use harms, or the potential marijuana to be used as a medication. MethodsWe surveyed national convenience samples of pediatric endocrinologists (N = 142) and rheumatologists (N = 83) and used descriptive statistics and multivariate logistic regression to examine alcohol screening rates, barriers, and for medical use of marijuana, differences between subspecialist concerns. ResultsIn all, 36.4% of providers reported screening adolescent patients annually or more, and a majority expressed concerns about impacts on disease management (80.0%/80.0%) and symptom management (69.3%/53.3%) from alcohol and marijuana, respectively. Nearly equal proportions disagreed (30.2%), were neutral (34.7%), or agreed (35.1%) that some patients would benefit from medical marijuana, although majorities were not comfortable recommending marijuana (62.7%) and did not believe marijuana is standardized enough to be used as medication (57.8%). DiscussionFewer than half of the subspecialists in our study routinely screen their adolescent patients for substance use, although many have concerns regarding the impacts of alcohol and marijuana use on their patients. Education and training on best practice could help to increase screening rates. There is agreement that marijuana is not standardized enough to be used as a medication. There is also a broad range of opinions regarding the pharmaceutical potential of marijuana and concerns about the impact of marijuana on underlying chronic medical conditions, which should be considered as marijuana policy continues to evolve.

Equitability of Depression Screening After Implementation of General Adult Screening in Primary Care

Depression is a debilitating and costly medical condition that is often undertreated. Men, racial and ethnic minority individuals, older adults, and those with language barriers are at increased risk for undertreatment of depression. Disparities in screening may contribute to undertreatment. To examine depression screening rates among populations at risk for undertreatment of depression during and after rollout of general screening. This cohort study from September 1, 2017, to December 31, 2019, of electronic health record data from 52 944 adult patients at 6 University of California, San Francisco, primary care facilities assessed depression screening rates after implementation of a general screening policy. Patients were excluded if they had a baseline diagnosis of depression, bipolar disorder, schizophrenia, schizoaffective disorder, or dementia. Screening year, including rollout (September 1, 2017, to December 31, 2017) and each subsequent calendar year (January 1 to December 31, 2018, and January 1 to December 31, 2019). Rates of depression screening performed by medical assistants using the Patient Health Questionnaire-2. Data collected included age, sex, race and ethnicity, and language preference (English vs non-English); to compare English and non-English language preference groups and also assess depression screening by race and ethnicity within the English-speaking group, a single language-race-ethnicity variable with non-English language preference and English language preference categories was created. In multivariable analyses, the likelihood of being screened was evaluated using annual logistic regression models for 2018 and 2019, examining sex, age, language-race-ethnicity, and comorbidities, with adjustment for primary care site. There were 52 944 unique, eligible patients with 1 or more visits in one of the 6 primary care practices during the entire study period (59% female; mean [SD] age, 48.9 [17.6] years; 178 [0.3%] American Indian/Alaska Native, 13 241 [25.0%] English-speaking Asian, 3588 [6.8%] English-speaking Black/African American, 4744 [9.0%] English-speaking Latino/Latina/Latinx, 760 [1.4%] Pacific Islander, 22 689 [42.9%] English-speaking White, 4857 [9.0%] English-speaking other [including individuals who indicated race and ethnicity as other and individuals for whom race and ethnicity data were missing or unknown], and 2887 [5.5%] with language barriers [non-English language preference]). Depression screening increased from 40.5% at rollout (2017) to 88.8% (2019). In 2018, the likelihood of being screened decreased with increasing age (adusted odds ratio [aOR], 0.89 [95% CI, 0.82-0.98] for ages 45-54 and aOR, 0.75 [95% CI, 0.65-0.85] for ages 75 and older compared with ages 18-30); and, except for Spanish-speaking patients, patients with limited English proficiency were less likely to be screened for depression than English-speaking White patients (Chinese language preference: aOR, 0.59 [95% CI, 0.51-0.67]; other non-English language preference: aOR, 0.55 [95% CI, 0.47-0.64]). By 2019, depression screening had increased dramatically for all at-risk groups, and for most, disparities had disappeared; the odds of screening were only still significantly lower for men compared with women (aOR, 0.87 [95% CI, 0.81 to 0.93]). In this cohort study in a large academic health system, full implementation of depression screening was associated with a substantial increase in screening rates among groups at risk for undertreatment of depression. In addition, depression screening disparities narrowed over time for most groups, suggesting that routine depression screening in primary care may reduce screening disparities and improve recognition and appropriate treatment of depression for all patients.