Prevention In Primary Care Research Articles

199. Adolescent Relationship Abuse Education and Prevention in Pediatric Primary Care: Provider, Adolescent, and Parent Perspectives

199. Adolescent Relationship Abuse Education and Prevention in Pediatric Primary Care: Provider, Adolescent, and Parent Perspectives

Understanding the scope of preventable acute care spending among patients with eating disorders.

The economic burden of eating disorders is substantial. One potential way to reduce costs, without sacrificing care, may be to target preventable (i.e., potentially unnecessary) acute care. This study sought to determine the amount and proportion of preventable and non-preventable acute care spending among individuals with eating disorders. We undertook a population-based, cross-sectional study of all individuals over the age of 17 with eating disorders (diagnosed through hospitalization) in Ontario, Canada, to determine potentially preventable and non-preventable acute care spending. Preventable acute care (i.e., preventable emergency department visits and hospitalizations) was defined using previously validated algorithms. We undertook analyses for the full sample, by sex and by eating disorder diagnosis (anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, multiple). Among 7547 individuals with eating disorders, 15% of all acute care spending (i.e., $1.33 million) was considered preventable; this figure was higher for females (14%) and those with bulimia nervosa (21%). Among emergency department visits, 25% of visits were considered preventable; the largest proportions were for non-emergent (11%) and primary care treatable (10%) conditions. Among hospitalizations, 9% were considered preventable; the highest proportions of preventable care spending were for short-term diabetes complications (1.8%) and urinary tract infections (1.8%). Although the economic burden of eating disorders is substantial, there is some scope to decrease acute care spending among this patient population. Care coordination and improved access to primary care and disease prevention, particularly related to diabetes, may help prevent the occurrence of some acute care episodes. Many jurisdictions have implemented strategies to reduce costs and improve the quality of care among patients with high health care needs, such as those with eating disorders; however, it is unclear whether any costs can be reduced and, if so, which costs. Cost-savings resulting from the reduction of unnecessary care could provide further economic justification for increased investment in outpatient care for individuals with eating disorders.

Consultation frequency and general practitioners’ and practices’ characteristics

BackgroundHigh workloads generated by a few patients who consult very frequently can become huge burdens for general practitioners (GPs). Patient-related factors have been repeatedly associated with frequent consultations, but there is evidence that GPs can also influence that frequency. We investigated how patients, GPs and their practices’ organisational characteristics were associated with consultation frequency.MethodsData came from the SPAM Prev (Swiss Primary Health Care Active Monitoring, Prevention in primary care) national, cross-sectional survey conducted in 2015–16, including 167 GPs and 1105 patients. GPs completed an online questionnaire focused on practice organisation. Patients randomly recruited in general practices completed a questionnaire with fieldworkers. Factors predicting consultation frequency were investigated using multilevel Poisson regression models.ResultsNegative associations with consultation frequency were found for females (Incidence Rate Ratio (IRR) 0.94, 95%CI [0.88–1.01]), less compliant patients (IRR 0.91, 95%CI [0.84–0.98]), high self-perceived health status (IRR 0.8, 95%CI [0.75–0.84]) and physical exercise (IRR 0.87, 95%CI [0.81–0.94]). Consultation frequencies were higher among patients with sleeping problems (IRR 1.08, 95%CI [0.96–1.23]), psychological distress (IRR 1.66, 95%CI [1.49–1.86]), chronic diseases (IRR 1.27, 95%CI [1.18–1.37]) and treatment with medication (IRR 1.24, 95%CI [1.12–1.37]). Positive associations with consultation frequency were found among GPs working longer hours (IRR 1.21, 95%CI [1.01–1.46]). Using shared medical records (IRR 0.79, 95%CI [0.67–0.92]) were negatively associated with consultation frequency.ConclusionGPs’ practices’ characteristics, like patients’, are predictive of patients’ consultation frequency, but those associations’ underlying mechanisms require further qualitative investigation. These new findings could help optimise intervention strategies and reduce healthcare costs.

Actual and Potential Role of Primary Care Physicians in Cancer Prevention.

Although the role of primary care in cancer prevention has been proven, its assumptions are still insufficiently implemented and the actual rates of cancer prevention advice delivery remain low. Our study aimed to identify the actual and potential role of primary care physicians (PCPs) in the cancer prevention area. Design of the study is a cross-sectional one, based on a survey of 450 PCPs who took part in a nationwide educational project in Poland. Only 30% of PCPs provide cancer prevention advice routinely in their practice, whereas 70% do that only sometimes. PCPs' actual role in cancer prevention is highly unexploited. They inquire routinely about the patient's smoking history (71.1%), breast cancer screening program (43.7%), cervical cancer screening (41.1%), patient's alcohol consumption (34%), patient's physical activity levels (32.3%), body mass index (29.6%), the patient's eating habits (28%) and patient's potential for sun/UV-Ray exposure (5.7%). The potential role of PCPs in cancer prevention is still underestimated and underutilized. Action should be taken to raise awareness and understanding that PCPs can provide cancer prevention advice. Since lack of time is the main obstacle to providing cancer prevention advice routinely, systemic means must be undertaken to enable PCPs to utilize their unquestionable role in cancer prevention.

Oral health and mental health in healthy adults, a topic of primary prevention and health care, empirical results from two online studies

Oral health is an important, yet often neglected aspect of health and well-being. Among geriatric populations, oral diseases, poor oral health, and reduced oral hygiene behavior are major comorbid factors of geriatric diseases such as dementia, cardiovascular diseases, or mental health conditions. However, little is known so far about the relationships between oral health and mental health in the younger adult population, who is yet not suffering from any disorder. In the present manuscript the results of two online studies, online study 1, n = 133, all-female sample and online study 2: n = 29, mixed gender sample, are reported that investigate the relationship between self-reported oral health impairments and preclinical symptoms of mental disorders including self-reported symptoms associated with depression or eating disorders as well as self-reported perceived stress and behavior change related to the COVID-19 pandemic. The results of both studies support links between self-reported oral health impairments, self-reported depressive symptoms (including anxiety and current affect) and symptoms related to eating disorders (such as bulimic behavior, body dissatisfaction or drive for thinness) among young adults and suggest that perceived stress may contribute to both, impaired oral health and impaired mental health in young adults (women and men).

Uloga kvaternarne prevencije u radu lekara primarne zdravstvene zaštite - pregled literature

The concept of quaternary prevention was integrated in 1999. into the international WONCA vocabulary as actions taken to identify patients at risk of overprescribing drugs and diagnostic procedures that would do them more harm than good. The aim was to determine the place and role of quaternary prevention in primary care. The papers published until 31.12.2022. have been analyzed. We searched Medline, PubMed, Cochrane Library, Scopus, Google Scholar, Science Direct, Mendeley, Serbian medical journals, books, strategies, and doctoral theses. The terms we used were: quaternary prevention, general medicine, overmedication, and diagnostic procedures. We restricted ourselves to works written in Serbian, English, and Croatian. Search has been performed from 01.09.2022. to 31.12.2022. Preferred Reporting Items for Systematic Review (PRISMA) scale parts were used to determine the validity of the papers collected. A total of 1899 papers were identified. We did not find meta-analyses, systematic literature reviews, and randomized studies. A total of 194 were analyzed. Highlighted as relevant 36. Quaternary prevention in primary care refers to the overuse of radiological and laboratory examinations, antibiotics, screening, individual patient access, good communication, reliance on evidence-based medicine, the workload in teams of selected doctors, and prompt consent to patient requests. Some sick patients are undiagnosed, concerned about their health, with functional problems, psychosomatic disorders, and unusual behavior during illness. Quaternary prevention has a place in breast and prostate cancer screening, immunization, mental health and osteoporosis drug marketing, hypertension, prediabetes, and dyslipidemia, a private health insurance program, and the use of high-resolution diagnostic technology. The most powerful way to avoid unnecessary medical procedures is to consistently apply evidence-based medicine.

АНАЛИЗ ВЕДУЩИХ ЭПИДЕМИОЛОГИЧЕСКИХ ПОКАЗАТЕЛЕЙ САХАРНОГО ДИАБЕТА СРЕДИ ВЗРОСЛОГО НАСЕЛЕНИЯ СЕВЕРНОГО РЕГИОНА

The study aims to analyze epidemiological situation for diabetes mellitus, with its complications and outcomes, in the adult population of the Khanty-Mansi Autonomous Okrug – Ugra by January 1, 2022. The analysis is conducted on the basis of the regional component of the Federal Register using diabetes mellitus data for 2021. It is determined that leading epidemiological indicators of diabetes mellitus in the region correspond to global and Russian trends and pace. Diabetic polyneuropathy, diabetic retinopathy, and diabetic nephropathy are leading microangiopathic complications in diabetes mellitus. Monitoring of leading clinical and demographical indicators of diabetes mellitus allows for optimization and planning of medical care for the region’s population, decision-making in primary and secondary preventive care of diabetes mellitus, patient logistics and routing, and advancing of screening and early diagnosis approaches.

Identifying the Main Factors of Providing Primary Preventive Care Services to the Elderly in Iran

Objectives: The ageing of the population lead to various problems in terms of health care. An important issue related to the promotion of elderly health is preventive care. The health care systems make appropriate changes in the structure and process of providing these services to the patients. This study aims to identify the most important factors of providing primary preventive care services to the elderly in Iran. Methods & Materials: In this descriptive-survey study, the variables were measured using a questionnaire and the causal relationships between them were identified. First, the factors affecting the provision of primary preventive care services to the elderly in selected countries including Iran were compared. Then, using the experiences of a panel of experts (n=12), an initial questionnaire was designed. To obtain consensus from the panel of experts, a Delphi process was carried out in three rounds. After determining the face and content validity of the questionnaire and assessing its reliability using Cronbach’s alpha coefficient, the questionnaire were completed by 176 experts. To measure the effect of the components on the main variable, the structural equation modeling (SEM) was used. Results: The model had 6 dimensions (planning, organizing, resource supply, monitoring, leadership, and preventive care). The factor load for the variable of planning was 0.68 (t=5.22); for organization, 0.56 (t=4.54); for resource supply, 0.47 (t=3.65); for monitoring, 0.59 (t=2.67); for leadership, 044 (t=3.05); and for preventive care, 0.650 (t= 3.85). Eight indicators were identified for the planning dimension, six indicators for the organization dimension, seven indicators for the resource supply dimension, seven indicators for the monitoring dimension, three indicators for the leadership dimension, and six indicators for the preventive care dimension. Conclusion: Planning, preventive care, monitoring, organizing, resource supply, and leadership are the most important factors of the provision of primary preventive care services to the elderly in Iran. Development of infrastructure, scientific and practical measures, promoting the health culture, and the seriousness of the health system in using the existing capacities and facilities, can help increase the quality of life and reduce health costs and disease burden in the elderly.

Adaptive changes in sensorimotor processing in patients with acute low back pain

In low back pain (LBP), primary care and secondary prevention of recurrent and persistent LBP are not always successful. Enhanced understanding of neural mechanisms of sensorimotor processing and pain modulation in patients with acute LBP is mandatory. This explorative fMRI study investigated sensorimotor processing due to mechanosensory stimulation of the lumbar spine. We studied 19 adult patients with acute LBP (< 4 weeks of an acute episode) and 23 healthy controls. On a numeric rating scale, patients reported moderate mean pain intensity of 4.5 out of 10, while LBP-associated disability indicated mild mean disability. The event-related fMRI analysis yielded no between-group differences. However, the computation of functional connectivity resulted in adaptive changes in networks involved in sensorimotor processing in the patient group: Connectivity strength was decreased in the salience and cerebellar networks but increased in the limbic and parahippocampal networks. Timewise, these results indicate that early connectivity changes might reflect adaptive physiological processes in an episode of acute LBP. These findings raise intriguing questions regarding their role in pain persistence and recurrences of LBP, particularly concerning the multiple consequences of acute LBP pain. Advanced understanding of neural mechanisms of processing non-painful mechanosensations in LBP may also improve therapeutic approaches.

Association between community environment and dependency among the elderly people from a service provision perspective

BackgroundThe incidence of dependency is high among the elderly people worldwide and increases with increasing life expectancy. The purpose of this study was to establish from the perspective of resource demand the association between community environmental resources and dependency among the elderly people.MethodsThis study is a cross-sectional design based on community from 22 locations in China. A multistage sampling method was used to select the study objects. The questionnaires were used to collect the survey data by face-to-face interviews. A total of 950 individuals completed the survey, and 913 individuals were available for this analysis. Dependency and community environment were measured using the standard instruments. Logistic regression analysis was performed to identify the community environment factors associated with dependency. Cluster analysis was used and demonstrated that dependency was mainly associated with community primary preventive care service resources.ResultsIn the group aged under 70 years, the utilization of electronic health records and the need for health assessments, and rehabilitation equipment rentals were significantly associated with the levels of dependency scores: the OR was 2.81, 2.25 and 2.13 (P < 0.05), respectively. In the group aged 70 years and over, a short-term care home was strongly associated with levels of dependency: the OR was 4.01 (P = 0.002). The daycare and nursing service, transportation service, and regular lectures on health knowledge were associated with levels of dependency: the OR was 2.41, 1.86 and 1.93 (P < 0.05). In the group with low social support, an emergency call or monitoring system, transportation services, the need for health assessment, and regular lectures on health knowledge were significantly associated with levels of dependency: the OR was 2.42, 2.19, 1.89 and 1.98 (P < 0.05), respectively.ConclusionsCommunity environment resources were significantly associated with dependency. These results suggest that the dependent on local environment resources may consider as the resource needs among elderly people.

Inadequate management of cardiovascular risk factors prior to admission for an acute coronary event.

Optimal regulation of modifiable risk factors has been proposed as the standard of care both for primary and secondary prevention of cardiovascular disease (CVD). The aim of this study was to assess primary and secondary cardiovascular risk management received before admission for an acute coronary event. Data were analyzed for 185 consecutive hospitalized patients with a diagnosis of acute coronary syndrome (ACS) in the Cardiology department of a University hospital during an annual period (1/7/2019 until 30/6/2020). The study population was divided into two groups, the primary and secondary prevention subgroups, according to previous medical history of cardiovascular disease (CVD). The mean age of the participants was 65.5 ±12.2 years and most patients were male (81.6%). Previous CVD was present in 51 patients (27.9%). Fifty-seven patients (30.8%) had a history of diabetes mellitus (DM) and 97 (52.4%) had a history of dyslipidemia. Hypertension was present in 101 (54.6%) patients. In the secondary prevention group, the LDL-C was on target in only 33.3% of the patients, while 20% patients did not use statins. The use of antiplatelet/anticoagulant agents was 94.5%. Among patients with diabetes, only 20% had been using a GLP-1 receptor agonist or/and an SGLT-2 inhibitor, while the HbA1c was on target in 47.8%. Twenty-five percent of the patients were active smokers. In the primary prevention group, the use of statins was overall low (25.8%) but more frequent in patients with diabetes and those without diabetes at very high-risk for CVD (47.1% and 32.1% respectively). The LDL-C was on target in less than 23.1% of the patients. The use of antiplatelet/anticoagulant agents was low (20.1%), but higher in those with diabetes (52.9%). In the diabetic group, HbA1c was on target in 61.8%. Active smoking was practiced by 46.3% of the patients. Our data show that in a substantial proportion of patients presenting with ACS, previous CVD prevention, both primary and secondary, fails to meet the current recommendations provided by scientific societies.

Hospital utilisation and the costs associated with complications of ICD implantation in acontemporary primary prevention cohort.

Implantation of an implantable cardioverter defibrillator (ICD) is standard care for primary prevention of sudden cardiac death. However, ICD-related complications are increasing as the population of ICD recipients grows. ICD-related complications in anational DO-IT Registry cohort of 1442 primary prevention ICD patients were assessed in terms of additional use of hospital care resources and costs. During amedian follow-up of 28.7months (IQR 25.2-33.7) one or more complications occurred in 13.5% of patients. Acomplication resulted in asurgical intervention in 53% of cases and required on average 3.65 additional hospital days. The additional hospital costs were €6,876 per complication or €8,110 per patient, to which clinical re-interventions and additional hospital days contributed most. Per category of complications, infections required most hospital utilisation and were most expensive at an average of €22,892. The mean costs were €5,800 for lead-related complications, €2,291 for pocket-related complications and €5,619 for complications due to other causes. We estimate that the total yearly incidence-based costs in the Netherlands for hospital management of ICD-related complications following ICD implantation for primary prevention are €2.7million. Complications following ICD implantation are related to asubstantial additional need for hospital resources. When performing cost-effectiveness analyses of ICD implantation, including the costs associated with complications, one should be aware that real-world complication rates may deviate from trial data. Considering the economic implications, strategies to reduce the incidence of complications are encouraged.

The Role of Pharmacists in Providing Pharmaceutical Care in Primary and Secondary Prevention of Stroke: A Systematic Review and Meta-Analysis.

Pharmacists deliver pharmaceutical care in many different healthcare settings and are well-placed to support the prevention of stroke. However, their role and impact in this area is ill-defined. This systematic review aims to explore the pharmacists’ role in stroke prevention. Nine databases were searched for studies reporting pharmacist interventions in the management of primary and secondary ischaemic stroke prevention. Study quality was evaluated through Cochrane Risk of Bias and Joanna Briggs Institute (JBI) appraisal tools where possible. A narrative review was conducted and meta-analysis performed for studies with comparable outcomes. Of the 834 initial articles, 31 met inclusion criteria. Study designs were varied and included controlled trials, observational studies, audit reports and conference abstracts. Seven studies addressed the pharmacists’ role in primary prevention and 24 in secondary prevention. Pharmacist interventions reported were diverse and often multifactorial. Overall, 20 studies reported significant improvement in outcomes. Meta-analysis showed pharmacist interventions in emergency care significantly improved the odds of achieving thrombolytic therapy door to needle (DTN) times ≤45 min, odds ratio: 2.69 (95% confidence interval (CI): 1.95−3.72); p < 0.001. The pharmacists’ role is varied and spans the stroke treatment pathway, with the potential for a positive impact on a range of health-related outcomes.

An Evidence-Based Review of Vitamin D for Common and High-Mortality Conditions.

Vitamin D is a fat-soluble vitamin available from food and sun exposure. Vitamin D receptors are present in cells throughout the body and cause it to act like a hormone. Observational studies document the association of low vitamin D levels with multiple health conditions. This article reviews the evidence for vitamin D in prevention and treatment in primary care. METHODS: We performed a literature review of randomized controlled trials, meta-analyses, systematic reviews, and large prospective trials looking at the role of vitamin D deficiency in the most common conditions seen in primary care and the top 10 causes of mortality since 2010. RESULTS: Vitamin D supplementation in patients with known cardiovascular disease does not reduce risk of stroke or heart attack. Vitamin D supplementation does not seem to have an effect in the treatment of hypertension or in cancer prevention. There is emerging evidence that supplementation reduces COVID-19 severity and risk of mechanical ventilation. Vitamin D at more moderate levels may reduce the risk of falls, but higher doses may cause increased fall risk. There does not seem to be a link between vitamin D supplementation and improved cognition. Vitamin D supplementation may be helpful in patients with major depression. High dose vitamin D may improve pain in people with fibromyalgia. Supplementing patients with prediabetes reduced the risk of progression to type 2 diabetes mellitus. Vitamin D supplementation in addition to standard emollient treatment helped to reduce symptoms in people with atopic dermatitis. CONCLUSION: Prospective studies of vitamin D supplementation demonstrate variable impact on disease specific and patient-oriented outcomes, suggesting a correlation but not a causal relationship between low vitamin D levels and disease pathogenicity. Future research should determine dosing standards and timing of vitamin D in treatment and prevention.

Primary Care Provider Use and Depression Screening Among Transitioning Adolescents and Young Adults with Sickle Cell Disease

Background Sickle cell disease (SCD) is a red blood cell disorder that impacts approximately 100,000 Americans. Adolescents and young adults (AYAs) with SCD face many barriers to successful transition from pediatric to adult care, including high rates of being uninsured, limited access to adult hematology and primary care providers (PCPs), and high rates of depression. Compared to people with SCD in other age groups, AYAs also have more healthcare costs, hospital visits, and greater rates of mortality. In other chronically ill populations, PCP use and well-managed depression are associated with improved outcomes. However, little is known about the prevalence of PCP use and how PCP use relates to mental health care and acute care use in this population near their transition. Thus, the objective of this study was to describe PCP use among transitioning AYAs with SCD and determine if being seen by a PCP in the year prior to transition was associated with receipt of depression screening and care and with decreased acute care utilization. Methods This was a single-site, retrospective review of electronic medical records (EMR) of AYAs 18-21 years old with SCD (any genotype) at Nationwide Children's Hospital (NCH) who had their last pediatric hematology clinic visit between 2015-2019. Patients were excluded if they had ever received a bone marrow transplant or were incarcerated at the time of transition. Demographics, PCP use, depression screening using the validated patient health questionnaire-9 (PHQ-9), and acute care utilization (emergency room and/or hospitalization visits) during their last year of pediatric care were abstracted. Data were analyzed in SPSS. Pearson's correlations and chi-square tests were used to determine significant associations between target variables. Results The final sample (N=56) included 32 (57%) females with mean age of 20.52 (SD=1.27). Of these, 55 (98%) were African/African American/Black, 1 (2%) was Arab; 37 (66%) had Medicaid insurance, 18 (32%) had private or commercial insurance, and 1 (2%) had military insurance. Overall, 51 (91%) patients had a PCP listed in their EMR, 30 (59%) had their PCP through NCH and 7 (23%) of these 30 had visited their PCP at least once in the year prior to their transition. Of the 30 with NCH PCP's, having ≥1 PCP visit in the year prior to transition was significantly associated with completing the PHQ-9 (p<0.01) and receiving a referral to psychiatry or therapy (p<0.01) compared to not having had a PCP visit. Patients who saw an NCH PCP in their final year of pediatric care had a mean of 5 acute care visits (SD= 3) compared to 6 visits (SD=8) among those without a visit to their PCP in their final year, this difference was not significant (p=0.440). Discussion Our results suggest that many AYAs with SCD are not receiving primary care in the year prior to transition to adult care. We also identified that those with a PCP visit may be more likely to receive depression screening and referral for mental health care than those without a PCP visit. These findings suggest that PCPs may play a crucial role in depression diagnosis and management for transitioning AYAs with SCD, which is critical to address due to the impact that undiagnosed and/or untreated depression can have on transition and SCD outcomes. Thus, increasing access to PCPs who can provide essential preventive primary care and mental health screenings may have the potential to impact successful SCD transition. Our study was limited by its retrospective nature and small sample size and because PCP care that may have been provided outside of NCH setting could not be evaluated. Additional studies, with larger samples and across multiple centers, are warranted to better understand PCP use, depression diagnosis and management, and how visits with a PCP can augment and optimize management of SCD.

Primary Preventive Care of Hematopoietic Stem Cell Transplantation Survivors: Time to Educate and Empower Recipients and Providers

Increasing use of hematopoietic stem cell transplantation (HCT) and improvements in recipient outcomes have led to a steady increase in the number of allogeneic HCT survivors. In addition to complications specific to the transplantation process, HCT recipients are at increased risk of developing cardiovascular disease (CVD) and subsequent neoplasm (SN). Strict surveillance of risk factors for CVD and cancer in the general population is recommended as an essential component of long-term follow-up (LTFU) care of HCT survivors, but implementation of this has been suboptimal. Various models for improving the provision of survivorship care have been proposed, including a hybrid/combined care approach wherein the HCT provider manages transplantation-specific complications and the primary care physician (PCP) provides general medical care, including surveillance and aggressive management of CVD risk factors and screening for SN. This model also offers a practical approach to LTFU care for HCT survivors who live at a distance from the HCT center, which is a reality for many recipients of HCT at The Ottawa Hospital (TOH). As the success of such a hybrid approach to survivorship care depends on the engagement of HCT recipients with their PCP and compliance with recommended general population surveillance, the aim of the present study was to assess the rates of PCP attendance and adherence to recommended preventive medicine interventions in the years immediately before and after HCT. We hypothesized that rates would be suboptimal and planned to use these results as a baseline for an educational initiative aimed at increasing awareness of HCT recipients and their PCPs about embracing preventive survivorship care. This was a single-center cohort study of allogeneic HCT recipients who underwent transplantation at TOH with linkage to population-based health administrative data. Published clinical practice guidelines were used to define recommended screening for CVD risk factors and cancer. The rates of annual PCP visits and utilization of recommended preventive care interventions in the 5 years before and after HCT were calculated for all eligible patients. Between 2014 and 2020, 409 patients with provincial health care coverage underwent allogeneic HCT at TOH. The median patient age was 51 years (range, 15 to 73 years), with a male predominance (60.9%). Approximately one-quarter of recipients did not attend a PCP visit in the 5 years before and after transplantation, and this proportion increased to one- third in the fifth year post-HCT. Among those recipients who were eligible, only 20% to 25% underwent recommended screening for dyslipidemia and diabetes. Cancer screening rates were also low, at 16% to 18% for cervical cancer, 18% to 22% for colon cancer, and 30% to 31% for breast cancer. These results highlight the need to increase awareness of HCT recipients and their PCPs about the risk of developing CVD and SN post-transplantation and to emphasize the potential to mitigate this risk by adhering to recommendations for surveillance to enable prompt intervention. Patient education should incorporate this information and empower HCT survivors to actively engage in their follow-up care and optimize their long-term outcomes.

Identifying factors explaining practice variation in secondary stroke prevention in primary care: a cohort study based on all patients with ischaemic stroke in the Stockholm region

ObjectivesThe aim of this study was to describe the practice variation in dispensation of secondary stroke preventive drugs among patients at different primary care centres (PCCs) in Stockholm region and...

Impact of prevention in primary care on costs in primary and secondary care for people with serious mental illness.

A largely unexplored part of the financial incentive for physicians to participate in preventive care is the degree to which they are the residual claimant from any resulting cost savings. We examine the impact of two preventive activities for people with serious mental illness (care plans and annual reviews of physical health) by English primary care practices on costs in these practices and in secondary care. Using panel two-part models to analyze patient-level data linked across primary and secondary care, we find that these preventive activities in the previous year are associated with cost reductions in the current quarter both in primary and secondary care. We estimate that there are large beneficial externalities for which the primary care physician is not the residual claimant: the cost savings in secondary care are 4.7 times larger than the cost savings in primary care. These activities are incentivized in the English National Health Service but the total financial incentives for primary care physicians to participate were considerably smaller than the total cost savings produced. This suggests that changes to the design of incentives to increase the marginal reward for conducting these preventive activities among patients with serious mental illness could have further increased welfare.

8.H. Workshop: Health equity and Chronic diseases: Public health and Primary care roles

Abstract Publicly funded health systems are based on the principle of universal access to care. However, significant gaps still exist between services needed and services received (i.e. unmet need for healthcare), especially in chronic disease management and prevention, particularly affecting marginalized groups in the society. Public Health and Primary Care should be working in integrated systems, as they are crucial in addressing health needs in the community and population at large. Several international organizations and leading scholars in the field have been advocating for the integration or primary care and public health to improve population health as well as to tackle complex issues such as multimorbidity. However, these two sectors are still working in silos across several countries, with a significant negative impact in terms of efficiency of the services provided and health care costs. The aim of this workshop will be to provide a global perspective on the issue of health equity in chronic disease management and prevention, with focus on marginalized population subgroups, such as elderly, immigrants and people from low socioeconomic status. We will discuss as well the determinants of unmet health needs for access to primary care in middle-aged and older adults, and examine the reasons for unmet need. We will further discuss about the need and strategies for enhanced integration between public health and primary care in chronic disease management and prevention. Key messages • Public health systems are based on the principle of universal access to care. However, significant gaps still exist between services needed and services received (i.e. unmet need for healthcare). • Public Health and Primary Care should be working in integrated systems to tackle complex issues such as multimorbidity.

Machine learning models for identifying pre-frailty in community dwelling older adults

BackgroundThere is increasing evidence that pre-frailty manifests as early as middle age. Understanding the factors contributing to an early trajectory from good health to pre-frailty in middle aged and older adults is needed to inform timely preventive primary care interventions to mitigate early decline and future frailty.MethodsA cohort of 656 independent community dwelling adults, aged 40–75 years, living in South Australia, undertook a comprehensive health assessment as part of the Inspiring Health cross-sectional observational study. Secondary analysis was completed using machine learning models to identify factors common amongst participants identified as not frail or pre-frail using the Clinical Frailty Scale (CFS) and Fried Frailty Phenotype (FFP). A correlation-based feature selection was used to identify factors associated with pre-frailty classification. Four machine learning models were used to derive the prediction models for classification of not frail and pre-frail. The class discrimination capability of the machine learning algorithms was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, F1-score and accuracy.ResultsTwo stages of feature selection were performed. The first stage included 78 physiologic, anthropometric, environmental, social and lifestyle variables. A follow-up analysis with a narrower set of 63 variables was then conducted with physiologic factors associated with the FFP associated features removed, to uncover indirect indicators connected with pre-frailty. In addition to the expected physiologic measures, a range of anthropometric, environmental, social and lifestyle variables were found to be associated with pre-frailty outcomes for the cohort. With FFP variables removed, machine learning (ML) models found higher BMI and lower muscle mass, poorer grip strength and balance, higher levels of distress, poor quality sleep, shortness of breath and incontinence were associated with being classified as pre-frail. The machine learning models achieved an AUC score up to 0.817 and 0.722 for FFP and CFS respectively for predicting pre-frailty. With feature selection, the performance of ML models improved by up to + 7.4% for FFP and up to + 7.9% for CFS.ConclusionsThe results of this study indicate that machine learning methods are well suited for predicting pre-frailty and indicate a range of factors that may be useful to include in targeted health assessments to identify pre-frailty in middle aged and older adults.