Screening In Primary Care Research Articles

Facilitators and barriers to the introduction of atrial fibrillation screening in primary care: a qualitative descriptive study of general practitioners in primary care.

Atrial fibrillation (AF), the most common cardiac arrhythmia, is a major risk factor for stroke. AF is often asymptomatic and, if identified, treatment can be offered that can reduce stroke risk by up to two thirds. AF screening meets many of the Wilson Jungner criteria for screening. While AF screening is recommended in clinical practice and internationally, the optimal mode and location for AF screening remains under investigation. Primary care has been identified as a potential setting. This study aimed to identify facilitators and barriers to AF screening from the perspective of GPs. The study adopted a qualitative descriptive design conducted in the south of Ireland. 58 GPs were invited from the north Cork region to participate in individual interviews at their practices, rural and urban, with a view to recruiting a purposive sample of up to 12 GPs. The interviews were audio-recorded, transcribed verbatim and analysed using a framework analysis. Eight GPs (four male, four female) from five practices participated. Five GPs were from urban practices and three were from rural practices. Facilitators and barriers were sub-categorised into patient facilitators, practice facilitators, GP facilitators, patient barriers, practice barriers, GP barriers, attitudes to AF screening, willingness to facilitate and priority ranking. All eight participants expressed a willingness to engage in AF screening. Time was the barrier discussed most frequently by all participants along with the need for additional staff. Programme structure was the most discussed facilitator by all participants and patient awareness campaigns. Despite barriers to AF screening identified by GPs, there was a significant willingness to engage and identify potential facilitators to support such screening.

Barriers and Determinants to the Underutilized Hypertension Screening in Primary Care Patients in Hong Kong: A Mixed-Method Study.

(1) Background: Hypertension (HT) is the most common chronic condition, affecting approximately 1.13 billion people worldwide. Despite freely available blood pressure (BP) devices in primary care (PC) clinics, many patients do not regularly screen for HT and are untreated. (2) Methods: This study investigated the proportion of PC patients who did not screen for HT and the underlying reasons in Hong Kong. An explanatory mixed-method cross-sectional study was conducted in 2020, which included a questionnaire survey, office BP measurements, and subsequent semi-structured interviews. Adult patients who had no diagnosis of HT were recruited in a large PC clinic by convenience sampling. The relationships between not having HT screening and sociodemographic data were investigated by logistic regression. Twenty-four patients were purposefully sampled (based on demographics) and were interviewed until data saturation. (3) Results: Among 428 participants, 190 (44.4%) had not had HT screening in the last two years, but 197 (46.0%) had HT. No HT screening in the last two years or ever was associated with being male, being single, being of younger age, having no family history of HT, having no clinic visits in the last two years, employment status, and self-perceived HT condition. Most participants (77.8%) misinterpreted their BP readings. Individual, social, and healthcare service barriers were identified in patients' interviews. Many PC patients had no regular HT screening but around half had elevated BP. (4) Conclusion: The study results indicate that the barriers to HT screening were multifactorial. HT screening in PC is urgently needed.

Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada

Screening for amblyopia in primary care visits is recommended for young children, yet screening rates are poor. Although the prevalence of amblyopia is low (3%-5%) among young children, universal screening in schools and mandatory optometric examinations may improve vision care, but the cost-effectiveness of these vision testing strategies compared with the standard in primary care is unknown. To evaluate the relative cost-effectiveness of universal school screening and mandated optometric examinations compared with standard care vision screening in primary care visits in Toronto, Canada, with the aim of detecting and facilitating treatment of amblyopia and amblyopia risk factors from the Ontario government's perspective. An economic evaluation was conducted from July 2019 to May 2021 using a Markov model to compare 15-year costs and quality-adjusted life-years (QALYs) between school screening and optometric examination compared with primary care screening in Toronto, Canada. Parameters were derived from published literature, the Ontario Schedule of Benefits and Fees, and the Kindergarten Vision Testing Program. A hypothetical cohort of 25 000 children aged 3 to 5 years was simulated. It was assumed that children in the cohort had irreversible vision impairment if not diagnosed by an optometrist. In addition, incremental costs and outcomes of 0 were adjusted to favor the reference strategy. Vision testing programs were designed to detect amblyopia and amblyopia risk factors. For each strategy, the mean costs per child included the costs of screening, optometric examinations, and treatment. The mean health benefits (QALYs) gained were informed by the presence of vision impairment and the benefits of treatment. Incremental cost-effectiveness ratios were calculated for each alternative strategy relative to the standard primary care screening strategy as the additional cost required to achieve an additional QALY at a willingness-to-pay threshold of $50 000 Canadian dollars (CAD) ($37 690) per QALY gained. School screening relative to primary care screening yielded cost savings of CAD $84.09 (95% CI, CAD $82.22-$85.95) (US $63.38 [95% CI, US $61.97-$64.78]) per child and an incremental gain of 0.0004 (95% CI, -0.0047 to 0.0055) QALYs per child. Optometric examinations relative to primary care screening yielded cost savings of CAD $74.47 (95% CI, CAD $72.90-$76.03) (US $56.13 [95% CI, $54.95-$57.30]) per child and an incremental gain of 0.0508 (95% CI, 0.0455-0.0561) QALYs per child. At a willingness-to-pay threshold of CAD $50 000 (US $37 690) per QALY gained, school screening and optometric examinations were cost-effective relative to primary care screening in only 20% and 29% of iterations, respectively. In this study, because amblyopia prevalence is low among young children and most children in the hypothetical cohort had healthy vision, universal school screening and optometric examinations were not cost-effective relative to primary care screening for detecting amblyopia in young children in Toronto, Canada. The mean added health benefits of school screening and optometric examinations compared with primary care screening did not warrant the resources used.

Adapting an Electronic STI Risk Assessment Program for Use in Pediatric Primary Care.

Sexually transmitted infections (STIs) are an ongoing public health issue in adolescents. the Centers for Disease Control and Prevention and American Academy of Pediatrics have and continue to recommend STI screening in at-risk adolescents, however screening and testing continues to lag behind the need. We previously designed and implemented an electronic risk assessment tool to support STI testing in our pediatric emergency department. Pediatric primary care clinics may be better positioned for STI risk assessments, as they can offer greater privacy and confidentiality, a lower stress environment, and greater opportunity for longitudinal care. STI risk assessment and testing continues to be a challenge in this setting. The goal of this work was to evaluate the usability of our electronic tool to support adaptation and implementation in pediatric primary care practices. We conducted qualitative interviews of pediatricians, clinic staff, and adolescents from 4 pediatric practices as part of a study whose goal is to ultimately implement STI screening in pediatric primary care. The goal of the interviews were (1) to understand contextual factors related to STI screening in primary care, which we have reported previously, and (2) to obtain feedback on our electronic platform, the questionnaire content, and their perspective on implementing it in primary care settings, which we report here. We received quantitative feedback using the System Usability Scale (SUS). The SUS is a validated, reliable tool to measure the usability of hardware, software, websites, and applications. SUS scores range from a score of 0 to 100, with a score of 68 or higher indicating above average usability. We additionally obtained qualitative feedback via interviews and used inductive analysis to identify common themes. We recruited 14 physicians, 9 clinic staff, and 12 adolescents. Participants rated the tool highly using the SUS, with a median score of 92.5 (threshold for average usability is 68) and an interquartile range of 82.5 to 100. Thematically, all participants perceived a need for such a screening program and indicated the format would encourage more honest responses on the topic adolescents. We used these results to modify the questionnaire prior to implementing it into participating practices. We demonstrated that our electronic STI risk assessment tool had a high level of usability and could be adapted for use in pediatric primary care.

Practice patterns of fundoscopic examination for diabetic retinopathy screening in primary care, Al-Ahsa, Saudi Arabia

Background: Diabetes mellitus (DM) is a significant public health issue. It carries a variety of serious complications, the most prevalent of which is diabetic retinopathy. Methods: This cross-sectional and descriptive study was conducted at primary healthcare centers (PHCs). Responses were obtained using a structured, multi-point questionnaire with closed-ended questions. Informed consent and ethical approval were obtained. The data were analyzed using Statistical Packages for Social Sciences version 26.0 (IBM Corp., Armonk, NY). Results: Study participants comprised 103 family physicians, of whom 59.2% were male and 40.8% were female. Among them, 42.7% were practicing in rural areas. Data indicated that most participants (89.3%) had good overall knowledge regarding DM, but only 57.3% demonstrated good practice in terms of fundus examination. Conclusion: This study indicated limitations in terms of family physicians' pattern of fundoscopy examination in their patients with DM. Establishing an optometry clinic within each PHC might be a reasonable solution to this problem.

Use of telehealth for cancer screening in primary care during COVID-19: an analysis of the Council of Academic Family Medicine Educational Research Alliance Survey 2022

Use of telehealth for cancer screening in primary care during COVID-19: an analysis of the Council of Academic Family Medicine Educational Research Alliance Survey 2022

Lung cancer screening in primary care

This article reviews the evidence supporting low-dose CT to screen for lung cancer, and the risks, costs, and challenges of implementing broad-based screening for eligible patients. Increased familiarity with lung cancer screening guidelines by primary care and specialty clinicians presents an opportunity to improve lung cancer screening rates and to save lives from the most common cause of cancer death in the United States.

Mental health and substance use screening in HIV primary care before and during the early COVID-19 pandemic

Mental health and substance use screening in HIV primary care before and during the early COVID-19 pandemic

PS-P03-4: LOW LEVELS OF HYPERTENSION AWARENESS AND HIGH PROPORTIONS OF UNCONTROLLED BLOOD PRESSURE IN THE UNITED KINGDOM AND IRELAND

Objective: Globally, it is estimated that 10.4 million people die each year due to raised blood pressure (BP). Unfortunately, at least 40% of those with high BP globally are unaware of their condition. In the most recent UK and Ireland community-based data, 66.5% of people were unaware of their high BP(1). The UK and Ireland have taken part in the global May Measurement Month (MMM) campaign, in a bid to increase awareness of BP and to evidence the proportion of those in the community with undiagnosed high BP. The aim of this study was to investigate the large and combined 2017, 2018 and 2019 MMM dataset, to evidence the proportion of people with raised BP, undiagnosed hypertension and levels of hypertension not treated to target in the UK and Ireland. Design and method: As part of the MMM protocol, community-based opportunistic BP screening sites were set up across the UK and Ireland in places of worship, supermarkets, pharmacies, GP surgeries, workplaces, gyms and other public spaces in 2017, 2018 and 2019. A questionnaire recording medical history, lifestyle and demographics was used to collate participant information. BP was measured three times and the average of 2nd and 3rd readings used for analyses. Multiple imputations were performed to impute the mean BP, where data were missing. The term Hypertension was used for those with systolic BP >/ = 140 or diastolic BP >/ = 90 mmHg, or the participant was on BP medication. Controlled BP was considered as < 140 and < 90 mmHg. Results: Data on 22,910 individuals were analysed as part of the combined MMM dataset. Mean age of participants was 52 ± 18 years, with 60% reporting as female gender. See Table 1 below for the proportion of those considered hypertensive, levels of awareness and the proportion of hypertensives treated to target. Conclusion: In the largest community-based BP dataset to date in the UK and Ireland, our data highlight the concerning levels of people with high BP unaware of their condition and poor levels of controlled BP in hypertensive patients. Better community based and primary care screening initiatives are required to improve awareness and early identification of those at high risk of cardiovascular disease. REFERENCES: (1) McDonnell BJ, Rees E, Cockcroft JR, et al. May Measurement Month 2019: an analysis of blood pressure screening results from the UK and the Republic of Ireland. Eur Heart J Suppl. 2021 May;23 Suppl_B. 147–150.

Primary Care Screening Tool for Polycystic Ovary Syndrome: Step One in the Battle Against Non-Communicable Disease.

Polycystic ovary syndrome (PCOS) is often the first manifestation, in adolescents and young adults, of metabolic problems that may occur later. Early identification, timely referral and appropriate treatment can result in improved reproductive, metabolic and comprehensive health. However, unlike other components of metabolic syndrome, which can be diagnosed at primary care level, there is no inexpensive, clinical tool to screen for PCOS. We share a simple six-item questionnaire, structured in three domains, which can be used as a screening tool for the syndrome. This allows early diagnosis and management of the condition, facilitates a life course approach to health promotion, and lays the foundation for the prevention of other comorbid metabolic disorders. It also helps integrate national programmes concerning non-communicable disease and women's healthcare under one umbrella, thus optimizing and strengthening delivery of community care.

Yellowknife: Canada's First Circumpolar Family Medicine Residency Site.

Canada's Northwest Territories (NWT), like other regions in the circumpolar north primarily inhabited by Indigenous peoples, faces challenges in recruiting and retaining physicians. Communities in this vast, diverse region depend largely on external medical professionals for health care. Consequently, these communities receive discontinuous medical care from physicians who lack local knowledge and are available only temporarily. The shortage of physicians for people residing in northern Canada requires a sustainable, long-term solution. The authors describe establishing Canada's first circumpolar family medicine residency training site in Yellowknife, NWT. The site was launched in 2020 as a partnership between the University of Alberta, Alberta Health Services, and 3 local health authorities in the NWT. The residency site, which bases residents in the local community, is expected to positively impact family physician recruitment and retention by allowing residents to build connections with local communities and identify as a northern physician. As of fall 2022, 4 residents had trained with the Yellowknife family medicine residency site. Two of these 4 residents graduated in 2022, both of whom plan to continue practicing medicine in the NWT. Residents have positively influenced medical care in the NWT, providing care in close to 20 small and remote communities. The presence of residents decreased appointment wait-times for some teams by as much as 60%, improved primary care screening, and enabled the provision of medical services at critical times. Furthermore, their presence has fostered academic spirit in the medical communities and had a positive impact on the communities as a whole. The authors provide key insights and lessons learned from the establishment of the remote residency site. To develop and improve the site, continuous program evaluation is planned.

1441. LTBI screening cascade for non-US-born persons in a large health system assessed using EMR data

Abstract Background The majority of tuberculosis (TB) diagnosed in the US is reactivation TB in non-US-born (nUSb) persons. Guidelines recommend screening persons born in high TB burden countries for latent TB infection (LTBI) and treating if positive. We evaluated the LTBI cascade in primary care among nUSb persons in a large academic medical system in Washington State. Methods We used electronic medical record (EMR) data to evaluate the LTBI screening cascade. nUSb individuals were identified using the primary language recorded in the EMR. Place of birth is not routinely collected in the EMR. All persons with a non-English primary language who entered care and attended one or more primary care visits in UW clinics between April 2016- April2021 were identified and considered eligible for LTBI screening. Persons with a documented IGRA or tuberculin skin test were considered screened for LTBI. Prescription records were reviewed to determine LTBI treatment. Results 5148 persons with non-English primary language attended primary care visits 2016-2021 and considered eligible for LTBI screening. Eligible persons were 58.5% female, median age 41 (IQR 30-58). Primary WHO regions of origin were Asia (37%), the Americas (36%), and Africa (19%), with a minority from North Africa, Middle East, and Europe. 1012 (20%) had a documented history of LTBI testing (Quantiferon-GOLD (N=949) or tuberculin skin testing (N=63)). Among 296 (29%) persons with a positive test for LTBI, 140 (47%) were treated for LTBI. The highest proportion of persons tested for LTBI were patients attending the HIV clinic (120, 66%) and the International/Refugee clinic (227, 81%). The majority of eligible patients were seen outside these clinics (N=4687) in whom the percent of persons tested ranged from 3-18% (14% overall). LTBI cascade among non-US-born primary care patients IGRA: interferon-gamma release assay; TST: tuberculin skin test. Conclusion Although this subset underestimates the number of non-US-born individuals (since many non-US-born individuals use English as their primary language) eligible for screening, it nonetheless highlights the significant gap between actual and guideline-recommended screening in primary care, as well as further drop-off on the cascade from positive LTBI test to LTBI treatment. EMR platforms could be leveraged to prompt LTBI screening and treatment initiations in primary care to help achieve TB elimination goals in the US. Disclosures Adrienne E. Shapiro, MD, PhD, Vir Biotechnology: Support as a trial site paid to my institution and non-financial support for medical writing GlaxoSmithKline third party funding to Vir support H. Nina Kim, MD, MSc, Gilead Sciences: Grant/Research Support.

797. Investigation of HIV Clusters Among Hispanic/Latino Gay or Bisexual Men in Metro Atlanta, Georgia

Abstract Background In Metro Atlanta, Georgia, annual HIV diagnoses among Hispanic/Latino (H/L) adolescents and adults have increased since 2014 (Figure 1), and four HIV molecular clusters, consisting primarily of Hispanic/Latino gay or bisexual men and other men who have sex with men (HLGBM), were identified in 2021. In March 2022, the Georgia Department of Public Health, the Centers for Disease Control and Prevention, and four health districts of Metro Atlanta (Fulton, Gwinnett, DeKalb, and Cobb) launched an investigation to characterize the clusters, assess barriers to accessing HIV care and prevention services, and inform improvements to service delivery. Methods We described the four clusters using HIV surveillance data. We conducted semi-structured qualitative interviews with 29 HLGBM and 28 providers through purposive sampling. Iterative analyses were conducted daily, comparing findings across interviews to identify commonly mentioned barriers to accessing HIV care and prevention services. Results The four clusters varied in size (5–42 members) and proportion of H/L members (41–100%); one cluster included members reporting injection drug use (14%) (Table 1). Viral suppression among cluster members was high across clusters (87–100%). Overarching reported barriers to accessing medical services included lack of culturally and linguistically concordant services, fear of deportation, transportation, and financial barriers (Table 2). LGBTQ and HIV stigma, low STD/HIV awareness, low access to primary care and HIV screening in primary and urgent care settings, and limited community outreach and marketing were common barriers to accessing HIV prevention services. For pre-exposure prophylaxis (PrEP) specifically, fear of being perceived as promiscuous, limited PrEP knowledge, and concerns with side effects were barriers. Navigating the healthcare system was noted as the primary challenge in HIV care. Conclusion The investigation of four clusters affecting HLGBM identified opportunities to improve access to HIV prevention and PrEP services for this population. State and local partners are planning cluster response activities, including ways to provide low-barrier culturally and linguistically concordant services (Table 3). Disclosures All Authors: No reported disclosures.

Factors Likely to Affect the Uptake of Genomic Approaches to Cancer Screening in Primary Care: A Scoping Review.

Genomic tests are being developed for use in cancer screening. As most screening is offered in primary care settings, primary care provider and patient perceptions of such tests are likely to affect uptake. We conducted a scoping review to synthesize information on factors likely to affect patient and provider use of biospecimen collection and analysis for cancer screening, methods referred to as liquid biopsy or multi-cancer early detection (MCED) testing when used to detect multiple cancers. We ultimately identified 7 articles for review and analyzed them for major themes. None reported on primary care provider perspectives. Six articles focused on patient perceptions about testing for a single cancer (colorectal), and 1 reported on patient views related to testing for multiple cancers. Factors favoring this type of testing included its non-invasiveness, and the perceived safety, convenience, and effectiveness of testing. There is a dearth of information in the literature on primary care provider perceptions about liquid biopsy and MCED testing. The limited information on patient perceptions suggests that they are receptive to such tests. Research on primary care provider and patient test-related knowledge, attitudes, and behavior is needed to guide future implementation in primary care settings.

Remote Screening for Alcohol, Smoking, and Substance Involvement by Sex, Age, Lockdown Condition, and Psychological Care-Seeking in the Primary Care Setting during the COVID-19 Pandemic in México.

The COVID-19 pandemic has created a psychoactive substance use crisis in many countries, including México. Remote valid tools to identify high-risk groups in need for treatment are a prerequisite for cost-effective interventions in primary care settings. To determine the validity and correlates of the remote applications of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) with sex, age, and psychological care-seeking, offered remotely in primary settings, during the COVID-19 pandemic in Mexico, a total sample of 19,109 Mexicans, with an average age of 34.38years (SD = 12.28, range = 18-80), 65.8% of whom were women (n = 12,578), 29.6% in lockdown (5,660), 39.8% in partial lockdown (7,611), 30.60% not in lockdown (5,838), and 14.75% of whom were seeking psychological care (n = 2,819), completed ASSIST through a programmed Web application. The dimensionality of the scale to verify construct validity evidence was achieved through a confirmatory factor analysis model (CFA). We represented the distribution of subjects by sex, age, lockdown condition, and psychological care-seeking, based on their lifetime consumption in 2021. We also compared the total distribution by consumption risk level and recommended type of intervention, psychological care-seeking, and age. The tool included ten dimensions (one for each substance, such as tobacco use), confirmed through the CFA. In general, our findings indicated that men reported high lifetime psychoactive substance use and risky drug use levels. A high percentage of 18 to 19-year-old women reported lifetime tobacco and alcohol use. Additionally, a high number of all-age women reported lifetime sedative and opioid use. Also, a high proportion of partially lockdown participants reported lifetime drug use. Moreover, a high percentage of subjects seeking psychological care were at a moderate and high risk of drug use, which required brief or intensive treatment. Our findings indicate that it was possible to validate the factor structure of the programmed ASSIST for remote use. More men than women reported high lifetime psychoactive substance use and risky levels because of their consumption. At the same time, younger women reported similar and even higher lifetime tobacco, alcohol, and cocaine use than same-age men. More all-age women reported lifetime use of sedatives than all-age men. More all-age partially lockdown participants reported lifetime use of drugs. In general, subjects at greater risk and those requiring psychological care are more likely to seek care. Community and primary care screening will make it possible to implement effective early interventions to reduce the substance use risks associated with health emergencies. Future studies are required to determine the diagnosis of substance use disorders to evaluate the cut-off points in the screening test to discriminate between the presence and absence of symptoms and evaluate the effect of remote psychological care.

Racial and Ethnic Differences in Patient-Reported Acceptability of Adverse Childhood Experience (ACE) Screening in Adult Primary Care

Given the dose-response relationship between adverse childhood experiences (ACEs) and worse health outcomes, there has been a growing push for routine ACE screening in healthcare settings. This study explored differences in patient-reported acceptability of ACE screening among adult primary care patients. Participants were adult primary care patients at an academic safety-net internal medicine clinic. Of the 136 patients who elected to participate in this study, 131 (96%) submitted completed surveys. Adult primary care patients at an academic safety-net internal medicine clinic completed an ACE screener and follow-up survey assessing their reported acceptability of ACE screening. Patients were also asked to specify their race, ethnicity, gender, and age. Chi-square analysis and Fisher's exact tests were used to examine associations between variables. Among 131 patients, 37% reported 4 or more ACEs. Black/African American patients and Hispanic/Latinx patients were overrepresented in the high ACE score (4 +) group (p < 0.05). Over one in three of all patients did not find ACE screening to be an acceptable part of their primary care. After a Bonferroni adjustment, patient-reported acceptability was not statistically associated with patients' ACE score or patients' race, ethnicity, gender, or age. Notably, however, in our small sample of Native American and Hispanic/Latino patients, over half did not find ACE screening to be acceptable. There is insufficient evidence to conclude that patients find ACE screening to be an acceptable part of their primary care. Our study is the first to explore how patient-reported acceptability may vary with patient demographics. While our findings revealed no significant associations between patient demographics and acceptability, trends observed within our study suggest that future studies with larger and more representative samples are needed. We consider routine ACE screening to be unsubstantiated and premature, and instead encourage the development of comprehensive trauma-informed practices for which a disclosure of childhood adversity is not necessary.

Mental Health Screening in Pediatric Primary Care: Factors Associated With Screening Completion and Elevated Scores.

This study aimed to examine predictors of complete and elevated youth mental health screens. Parents of 4- to 11-year-old children completed the Strengths and Difficulties Questionnaire (SDQ) during a routine, universal mental health screening initiative in primary care. Bivariate logistic regressions were run to examine associations between independent (visit age, sex, race/ethnicity, language, insurance, and guardian) and dependent variables (screening completion and elevated SDQ score). Parents of younger and Spanish-speaking (vs English-speaking) children were less likely to have a complete SDQ screen. Among those with complete SDQ screens, older children, male children, those with public or no insurance, and those who had a mother (vs father) complete the screener were more likely to have an elevated score. Understanding patterns of screening completion rates and predictors of elevated screens provides valuable information to improve resource mapping and planning. Findings can inform mental health screening implementation and optimization within primary care.

Obesity screening in the pediatric emergency department – A missed opportunity?

ObjectivesThere is a low rate of body mass index measurements and obesity screening in primary pediatric care. Pediatric emergency department (PED) visits, with their large volumes and routine weight measurements, provide a unique opportunity to identify and address obesity. The study objectives were to examine the rate of addressing obesity in the PED and to identify its predicting factors. MethodsFrom electronic medical records of PED visits during 2010–2019, we extracted data on age, gender, weight, time, listed diagnoses, and discharge texts. The primary outcome was a listed diagnosis of “obesity” on discharge letters of children with obesity. Secondary outcomes were addressing weight in the discharge letter and written recommendations for obesity-related treatment. Mixed models were used to test for associations between each of the three outcomes and patient/visit characteristics. ResultsThere were 150,250 PED visits by 88,253 different children and adolescents. Obesity was found in 10,691 children (12.1%). Among these, listed “obesity” diagnosis was present in only 240 (1.5%) visits. Text addressing overweight/obesity was recorded in 721 (4.4%) visits, and weight-related recommendations were documented in 716 (4.4%) visits. “Obesity” was documented in females more often than in males, in older children, in children with higher weights, and in visits conducted during the mornings. ConclusionsThe rate of obesity diagnosis in the PED was extremely low, hence the potential screening ability of the PED in this matter is highly under-utilized. PEDs could increase the recognition of obesity, thus assisting in the global efforts in tackling this disease.

Incorporation of plasma biomarkers for screening and diagnosis in primary care

AbstractBackgroundPlasma biomarkers that reflect Alzheimer’s neuropathological changes are under FDA consideration for approval as diagnostic tests. Their use in primary care will become feasible, and it will be difficult to limit biomarker screening to symptomatic or high risk individuals, especially as symptoms of cognitive decline are often nonspecific.MethodsAs members of the NIA Advisory Group on Risk Evidence Education for Dementia (AGREED), we have examined analytics of AD biomarkers in asymptomatic and symptomatic contexts, as well as language used in disclosure of biomarker results in research studies. We review recent data and describe key issues in plasma screening for Alzheimer’s Disease in primary care and propose directions for future research.ResultsCritical issues include: 1. Assessing accuracy of biomarker(s) measurement, and sensitivity and specificity of cutoffs to determine presence or absence of amyloid or other AD pathology. 2. Recognizing the critical need to study biomarkers in population‐based settings and among under‐represented individuals to understand factors that may modify cutoffs and normative data, e.g., age, sex, ethnicity, renal and hepatic function. 3. Data and models regarding the value of amyloid positivity to predict the development of Mild Cognitive Impairment (MCI) or dementia in asymptomatic individuals, and for progression of MCI to dementia. 4. Disclosure of APOE genotype if it is part of a biomarker risk algorithm. 5. Selecting nuanced language for describing positive, negative or indeterminate biomarker results, with clear explanations of what the tests measure, and risks associated with positive or negative results. 6. Current plasma biomarkers do not measure other pathologies and cognitions that may contribute to MCI and dementia, e.g., a‐synuclein, TDP43 or vascular pathology; depression, medical comorbidities, sleep disorders or medications that may adversely impact cognition. Together with biomarker results, the impact of these factors on cognition should be considered and discussed. 7. Screening for cognition is underdeveloped, limited by the types of tests currently used for screening and the time typically available to assess patients in primary care.ConclusionsFurther research on these topics and support and education of primary care providers is essential for the deployment of blood‐based biomarkers in primary care.

Development and validation of a machine learning-augmented algorithm for diabetes screening in community and primary care settings: A population-based study.

Opportunely screening for diabetes is crucial to reduce its related morbidity, mortality, and socioeconomic burden. Machine learning (ML) has excellent capability to maximize predictive accuracy. We aim to develop ML-augmented models for diabetes screening in community and primary care settings. 8425 participants were involved from a population-based study in Hubei, China since 2011. The dataset was split into a development set and a testing set. Seven different ML algorithms were compared to generate predictive models. Non-laboratory features were employed in the ML model for community settings, and laboratory test features were further introduced in the ML+lab models for primary care. The area under the receiver operating characteristic curve (AUC), area under the precision-recall curve (auPR), and the average detection costs per participant of these models were compared with their counterparts based on the New China Diabetes Risk Score (NCDRS) currently recommended for diabetes screening. The AUC and auPR of the ML model were 0·697and 0·303 in the testing set, seemingly outperforming those of NCDRS by 10·99% and 64·67%, respectively. The average detection cost of the ML model was 12·81% lower than that of NCDRS with the same sensitivity (0·72). Moreover, the average detection cost of the ML+FPG model is the lowest among the ML+lab models and less than that of the ML model and NCDRS+FPG model. The ML model and the ML+FPG model achieved higher predictive accuracy and lower detection costs than their counterpart based on NCDRS. Thus, the ML-augmented algorithm is potential to be employed for diabetes screening in community and primary care settings.