Opportunistic Screening In General Practice Research Articles

Barriers and facilitators to opportunistic chronic kidney disease screening by general practice nurses

Opportunistic screening in general practice (GP) is a cost-effective and viable approach to the early identification of chronic kidney disease (CKD). This study sought to identify the barriers and facilitators to CKD screening practices of GP nurses working in a regional area of New South Wales, Australia. An eight-item elicitation questionnaire informed by the Theory of Planned Behaviour was administered to a convenience sample of 26 GP nurses. Participants identified that the advantages of CKD screening were its early detection and treatment, the reduction of disease burden, and the opportunity to increase awareness and provide disease prevention education. These positive attitudinal beliefs were offset by negative beliefs about the impost of opportunistic screening on nursing time, particularly when there were other competing clinical priorities. Participants reported that practice doctors were wary of the financial costs associated with additional non-claimable services and believed that unfunded services, regardless of patient benefit, were difficult to justify in a private business environment. Screening was enabled in GP settings with existing screening protocols or initiatives, and when patients presented with known risk factors. Barriers to screening were more frequently described and illustrated a strong focus on financial aspects of GP. Without reimbursement through the Medicare Benefits Scheme, screening was not considered an economical use of nursing time. Other competing and billable clinical services took precedence. The findings of this study can be used to inform the development and evaluation of interventions that target opportunistic CKD screening in the GP setting.

NH2 What effect do practice visits have upon opportunistic chlamydia screening test uptake and case detection in primary care? An audit of 81 general practices in Oxfordshire

Background/Introduction The National Chlamydia Screening Programme in England aims to reduce transmission and prevent complications through early diagnosis. The ‘Value for Money’ review proposed opportunistic screening in general practice supported by specialist services. Aims/Objectives To evaluate the effect of practice visits upon chlamydia screening coverage and case identification in young people aged 15–24 in Oxfordshire, April 2012–March 2014. Methods Quarterly counts of total screens and positive tests for general practices in Oxfordshire were linked to records of practice visits (date, attendance) and characteristics of practices (location, deprivation, practice size). Testing and positivity rates three months prior to screening officer visits (baseline) were compared to rates in the 0–3 and 4–6 months following a visit. Pre- and post-visit counts were compared using multivariate generalised estimating equation models, accounting for repeated measures by practices and confounders. Results Practice screen counts were available for 136 periods before and after visits to 81 practices. Practices reported a median of 9 tests in the 3 months prior to visits or 3% screening coverage of registered 15–24 year olds. Screen counts were significantly higher following visits (Table 1), and positively associated with higher staff attendance at those visits. Also, there is an increase in number of positive cases diagnosed immediately after visits. Conclusion Practice visits serve as a good reminder for staff in general practice to offer test opportunistically. However, there is a need for an enhanced intervention to sustain any increase in screening coverage and diagnoses following visit.

Outside the Box: Proactive care: the patient’s right to choose

Professor Greenhalgh makes a valid point about the pitfalls of opportunistic screening in general practice.1 There will always be patients who find opportunistic health checks intrusive and entirely superfluous to their consultation with their GP. However, as Dr Greenhalgh points out herself, proactive care of this kind is often based on robust evidence and contributes significantly to practice income too. Allowing patients to …

The cost of diagnosing Type 2 diabetes mellitus by clinical opportunistic screening in general practice

Type 2 diabetes is associated with serious complications and shortens life. Its prevalence is increasing rapidly worldwide and no cure is available. One logical response is to diagnose the condition as early as possible. Clinical opportunistic screening is one mechanism for making the diagnosis before symptoms are reported. This paper reports the cost of using this technique in UK general practice. In one UK general practice, the electronic medical records were searched to determine the number of blood glucose and oral glucose tolerance tests undertaken for non-pregnant adults without known diabetes over three consecutive years. The laboratory, staff and administrative costs associated with these screening tests were calculated. The records of all patients newly diagnosed with Type 2 diabetes during the same period were reviewed to identify diagnoses made by clinical opportunistic screening. Total costs were divided by the number of diagnoses to determine a cost per diagnosis detected by opportunistic screening. During the study period, 5720 screening tests were conducted for 2763 patients. Over the 3 years, 86 patients were diagnosed with Type 2 diabetes, 54 (63%) via screening (yield 2.0%; number needed to screen 51.2). The screening costs totalled £ 20,372. The average cost per new screen-detected diagnosis was £ 377. Almost two-thirds of new cases of Type 2 diabetes can be detected before symptoms are reported, at reasonable cost by opportunistic screening in general practice, without the use of extra resources. As an affordable alternative to population screening, clinical opportunistic screening merits further consideration.

Screening for Type 2 Diabetes – The ADDITION Netherlands Study

To investigate whether early treatment of screening-detected diabetic patients is beneficial, the Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION) has been initiated. A total of 56,978 subjects 50–70 years of age without diabetes from 79 general practices in The Netherlands were invited to participate in a stepwise screening programme. Five hundred and eighty-six participants (1.0%) were diagnosed with type 2 diabetes. The score on the initial risk questionnaire was higher if glucose metabolism was more disturbed. The yield of screening varied widely between practices. A lower yield was not associated with an appropriate practice organisation regarding diabetes care, nor with a speciality of the GP in diabetes. Opportunistic screening in general practice seems preferable to population-based screening. Intensified multifactorial treatment of patients with screening-detected type 2 diabetes in general practice reduced the cardiovascular risk factor levels significantly after just one year without worsening healthrelated quality of life. After three years of follow-up, screened participants without diabetes but with an elevated risk score had comparable cardiovascular event rates to patients with diabetes. Screened individuals without diabetes are at risk of lacking optimal control of cardiovascular risk factors.

Identifying people at risk for undiagnosed type 2 diabetes using the GP's electronic medical record

Screening for type 2 diabetes is recommended in at-risk patients. The GP's electronic medical record (EMR) might be an attractive tool for identifying them. To assess the value of the GP's EMR in identifying patients at risk for undiagnosed type 2 diabetes and the feasibility to use this information in usual care to initiate screening. In 11 Dutch general practices (25 GPs), we performed an EMR-derived risk assessment in all patients aged > or =45 and < or =75 years, without known diabetes, identifying those at risk according to the American Diabetes Association recommendations. Patients with an EMR-derived risk or risk after additional risk assessment during regular consultation were invited for capillary fasting plasma glucose (FPG) measurement. Of 13 581 patients, 3858 (28%) had an EMR-based risk (hypertension, cardiovascular disease, lipid metabolism disorders and/or obesity). Additional risk assessment in those without an EMR-based risk showed that in 51%, greater than one risk factor was present, mainly family history (51.2%) and obesity (59%). Ninety per cent returned for the FPG measurement. In both groups, we found patients with an FPG exceeding the cut point for diabetes (5.9% versus 4.1%). With additional risk assessment during consultation, the GP's EMR was valuable in identifying patients at risk for undiagnosed type 2 diabetes. It was feasible to use this information to initiate screening. At-risk patients were willing to take part in screening. Better registration of family history and obesity will improve the EMR as a tool for identifying at-risk patients in opportunistic screening in general practice.

Chlamydial infection: an accurate model for opportunistic screening in general practice

Objectives: To estimate the prevalence of Chlamydia trachomatis in women in general practice and to assess risk factors associated with infection. Methods: The study was carried out in 2001–2 in...

Opportunistic screening for Chlamydia in general practice: the experience of health professionals.

Chlamydia trachomatis is the most common curable bacterial sexually transmitted infection in the UK. The infection is asymptomatic in up to 70% of women, and if untreated, can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Chlamydial infection can be diagnosed using urine testing and is easily treated with antibiotics. In 1999, the UK Department of Health funded a pilot opportunistic Chlamydia screening programme in two health authorities. All sexually active women between the ages of 16 and 24 years attending general practices and other healthcare settings, such as family planning clinics, antenatal clinics and genito-urinary medicine services, were offered the opportunity to be screened for Chlamydia, regardless of the purpose of their visit. This evaluation was funded to assess the feasibility and acceptability of opportunistic screening. The evaluation was conducted using both qualitative and quantitative methods. The present paper describes findings from the qualitative evaluation study arising from the health professionals' experience of opportunistic screening in general practice. Receptionists were central to the opportunistic screening model in general practice and it was this aspect of the model that raised most concerns. Whilst general practitioners reported that the involvement of receptionists saved them time, the receptionists themselves were sometimes drawn into discussions for which they felt ill equipped and unsuitably located. This research suggests that a call-recall national screening programme would provide a better model to undertake Chlamydia screening in general practice. The advantages of this model are threefold. First, each individual within the target age range can receive information about Chlamydia through the post. Secondly, the test and more detailed information can be managed by a practice nurse in a private and confidential setting. Thirdly, individuals are not repeatedly offered the test when visiting the surgery.

Opportunistic screening for chlamydia infection in general practice: can we reach young women?

To study opportunistic screening in primary care, in such a way that would include teenage women. Setting-Screening for chlamydia infection was offered opportunistically in eight general practices in Edinburgh to women aged < or = 35 years attending for cervical smear, and women aged < or = 20 years attending for contraception. The numbers of women eligible to be offered screening were 901 in the cervical smear group, and 595 in the contraception group. Effective screening rate (offered test, consented, and urine sample returned) was 30% for the cervical smear group compared with 23% for the contraception group. Among those tested, chlamydia prevalence was strongly associated with young age, ranging from 11.8% in those <18 years, to 0% in those >25 years. Number of sexual partners in past year did not improve prediction of infection. These findings raise concerns regarding the feasibility of opportunistic screening in general practice, particularly for those with highest prevalence of chlamydia--teenage women.

Where young people with multiple sexual partners seek medical care: implications for screening for chlamydial infection.

OBJECTIVE: To investigate among young people the relation between the number of sexual partners and use of medical services in order to guide planning of sexually transmitted disease screening. DESIGN:...

Primary health care and the addictions: where to start and where to go.

The development of community services for problem drinkers is briefly traced over the last 40 years. The numbers of drinkers in need of advice and treatment far exceeds the available resources. Family practice would be an ideal place in which to further primary care and prevention but lack of time, knowledge and motivation for probing into patients' drinking habits detract from the potential. A pilot study of opportunistic screening in general practice is described whereby a yellow label affixed to a patient's medical record card registers the average weekly alcohol intake. In a sample of 400 patients, 16% were high or intermediate risk drinkers. Each high risk drinker presented with a medical condition which could, in either aetiology or management, be related to high consumption. By discussing this, patients were often motivated to drink less or abstain. Various suggestions are made how better medical training and education could improve the diagnosis and treatment of drinking problems.