Health Screening In Primary Care Research Articles

Integrating substance use disorder screening in primary healthcare in Georgia: online survey of providers’ attitudes, knowledge, practice, and perceived barriers

ABSTRACT Background The study aimed to explore the attitudes, knowledge, and practices of primary healthcare providers in Georgia regarding screening and management of patients with substance use disorders (SUD). Methods An online survey of primary healthcare providers, descriptive statistics, bivariate analysis, and odds ratio calculations were used. Results The final sample consisted of 96 providers, vastly females, from 19 primary healthcare clinics in 7 cities. About one in five believed that family doctors need not systematically screen patients for risky or problematic use of any psychoactive substances. Only 1%–4% reported feeling fully ready to identify patients with illicit substance use concerns. Attitudes and practices varied depending on the type of substance being assessed, with the majority of respondents stating that illicit substance use is not a priority area and falls outside of their responsibilities. The most cited barrier for SUD screening was providers’ belief that patients do not truthfully disclose their substance use. Almost a third believed that people who use drugs were criminals. Conclusion Our study highlights the urgent need for targeted interventions to improve provider knowledge, attitudes, and practices related to SUD screening and management, with a focus on addressing stigma and implementing evidence-based screening protocols in primary healthcare settings.

A retrospective study of prostate-specific antigen and international prostate symptoms scores from participants at a men's health screening initiative in Trinidad.

This study describes the characteristics of men attending a primary health care screening initiative, determines the proportion of men who have elevated International Prostate Symptom Score (IPSS) scores and prostate-specific antigen (PSA) levels, and determines any correlation between these scores as indicators for benign prostatic hyperplasia (BPH) or prostate cancer. Data were collected from all patient records during men's health screening initiatives that occurred in December 2018, January 2019, and March 2019 in Trinidad and Tobago. A total of 350 medical records were analyzed to record patient demographics, PSA levels, and IPSS scores. Analysis of the data was performed with the use of Statistical Package for the Social Sciences software (version 27). Most men who attended the screening initiative belonged to the 61-65 age group (20.57%), with more than half of the men being married (57.71%) and employed (52.57%) and of patients with comorbidities (17%), the most prevalent included hypertension (6%) and diabetes mellitus (3.7%). A mean PSA level of 2.94 ng/ml and a mean IPSS of 7.62 were recorded. Moreover, 11.5% of the males had elevated PSA levels (>4 ng/ml) and 32.9% had elevated IPSS levels (>8). There were correlations between PSA and IPSS values (r = 0.161 and P = 0.006). Age was a predictor of both IPSS and PSA values (r = 0.214, P = 0.000 and r = 0.192, P = 0.000, respectively). Among diabetic participants, a small but significant correlation between IPSS and diabetes was shown (r = 0.223, P = 0.028). As a predictor of elevated IPSS, diabetes had an odds ratio of 1.132 (95% confidence interval (CI): 1.021-1.255). Our findings are similar to those described in previous studies; however, further investigations are required to fully describe the relationship between PSA and IPSS. This may assist in advancing screening measures and improving health outcomes for men with BPH and prostate cancer. Primary care physicians should recognize the possible association between BPH and diabetes mellitus and offer appropriate screening where indicated.

Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity.

Obesity reflects excessive fat deposits. At-risk individuals are guided by healthcare professionals to eat fewer calories and exercise more, often using body mass index (BMI; weight/height2) thresholds for screening and to guide progress and prognosis. By conducting a mini-narrative review of original articles, websites, editorials, commentaries, and guidelines, we sought to place BMI in the context of its appropriate use in population health, clinical screening, and monitoring in clinical care. The review covers studies and publications through 2023, encompassing consensus reviews and relevant literature. Recent consensus reviews suggest that BMI is a valuable tool for population surveys and primary healthcare screening but has limitations in predicting the risk of chronic diseases and assessing excess fat. BMI can guide nutritional and exercise counseling, even if it is inadequate for reliable individual risk prediction. BMI cut-offs must be reconsidered in populations of varying body build, age, and/or ethnicity. Since BMI-diagnosed overweight persons are sometimes physically and physiologically fit by other indicators, persons who are overweight on BMI should be more fully evaluated, diagnosed, and monitored with combined anthropometric and performance metrics to better clarify risks. The use of combined anthropometric and performance metrics involves integrating measurements of body composition with assessments of physical function and fitness to provide a more comprehensive evaluation of an individual's health and fitness status. Eligibility for bariatric surgery or semaglutide satiety/appetite-reduction medications should not be determined by BMI alone. Awareness of the advantages and limitations of using BMI as a tool to assess adult obesity can maximize its appropriate use in the context of population health and in rapid clinical screening and evaluation.

Association between sociodemographic factors, clinic characteristics and mental health screening rates in primary care.

Screening for mental health problems has been shown to be effective to detect depression and initiate treatment in primary care. Current guidelines recommend periodic screening for depression and anxiety. This study examines the association of patient sociodemographic factors and clinic characteristics on mental health screening in primary care. In this retrospective cohort study, electronic medical record (EMR) data from a 14-month period from 10/15/2021 to 12/14/2022 were analyzed. Data were retrieved from 18 primary care clinics from the Corewell Health healthcare system in West Michigan. The main outcome was documentation of any Patient Health Questionnaire (PHQ-4/PHQ-9/GAD-7) screening in the EMR within the 14-month period at patient level. General linear regression models with logit link function were used to assess adjusted odds ratio (aOR) of having a documented screening. In total, 126,306 unique patients aged 16 years or older with a total of 291,789 encounters were included. The prevalence of 14-month screening was 79.8% (95% CI, 79.6-80.0). Regression analyses revealed higher screening odds for patients of smaller clinics (<5,000 patients, aOR 1.88; 95% CI 1.80-1.98 vs. clinics >10.000 patients), clinics in areas with mental health provider shortages (aOR 1.69; 95% CI 1.62-1.77), frequent visits (aOR 1.80; 95% CI, 1.78-1.83), and having an annual physical / well child visit encounter (aOR 1.52; 95% CI, 1.47-1.57). Smaller positive effect sizes were also found for male sex, Black or African American race, Asian race, Latinx ethnicity (ref. White/Caucasians), and having insurance through Medicaid (ref. other private insurance). The 14-month mental health screening rates have been shown to be significantly lower among patients with infrequent visits seeking care in larger clinics and available mental health resources in the community. Introducing and incentivizing mandatory mental health screening protocols in annual well visits, are viable options to increase screening rates.

Knowledge, Attitude and Obstacles of Colorectal Cancer Screening in Primary Health Care in Bali, Indonesia

Background: The knowledge of CRC and its screening methods of healthcare workers is the bedrock of CRC early detection particularly in countries lacking national screening programs. Unknown factors influencing colorectal cancer early detection program implementation. We aimed to evaluate the knowledge and attitudes of primary health care (PHC) provider regarding CRC screening and identify the barriers associated with the screening plan.Methods: A cross-sectional study was conducted among PHC physicians and nurses in public primary health care centers in Bali, Indonesia. A 44-item self-administered questionnaire was used to assess the knowledge, attitude and practice of CRC screening. The questionnaire was spread using google form. Results: Two hundred and five respondents have participated in this study. The average duration of doing practice in PHC is 6.6 years. In knowledge of CRC, 50.2% of them have good knowledge, and there is no difference between PCPs vs nurses (51.9% vs 47.3%; p=0.53). In attitude toward CRC screening, 58.5% out of the have good attitude, and there is no difference between PCPs vs nurses (60.3% vs 55.4%; p=0.50). The barriers of the screening was divided into two areas, a barrier from the health care system and patients. There was no association between knowledge and attitude towards CRC screening (p=0.63).Conclusion: The majority of health workers' knowledge and attitudes toward CRC screening were in the "good" category. The patient's fear of being diagnosed with cancer, as well as the patient's fear and anxiety of screening tests, is the most significant barrier to colorectal cancer screening.

Knowledge, Attitude and Obstacles of Colorectal Cancer Screening in Primary Health Care in Bali, Indonesia

Background: The knowledge of CRC and its screening methods of healthcare workers is the bedrock of CRC early detection particularly in countries lacking national screening programs. Unknown factors influencing colorectal cancer early detection program implementation. We aimed to evaluate the knowledge and attitudes of primary health care (PHC) provider regarding CRC screening and identify the barriers associated with the screening plan.Methods: A cross-sectional study was conducted among PHC physicians and nurses in public primary health care centers in Bali, Indonesia. A 44-item self-administered questionnaire was used to assess the knowledge, attitude and practice of CRC screening. The questionnaire was spread using google form. Results: Two hundred and five respondents have participated in this study. The average duration of doing practice in PHC is 6.6 years. In knowledge of CRC, 50.2% of them have good knowledge, and there is no difference between PCPs vs nurses (51.9% vs 47.3%; p=0.53). In attitude toward CRC screening, 58.5% out of the have good attitude, and there is no difference between PCPs vs nurses (60.3% vs 55.4%; p=0.50). The barriers of the screening was divided into two areas, a barrier from the health care system and patients. There was no association between knowledge and attitude towards CRC screening (p=0.63).Conclusion: The majority of health workers' knowledge and attitudes toward CRC screening were in the "good" category. The patient's fear of being diagnosed with cancer, as well as the patient's fear and anxiety of screening tests, is the most significant barrier to colorectal cancer screening.

Mental Health Screening in Primary Care: A Literature Review

This literature review explores the role of mental health screening in primary care settings. It provides an overview of the prevalence and impact of mental health disorders, the importance of early detection and intervention, and the challenges faced by primary care providers in identifying and managing mental health conditions. The review also examines various screening tools and strategies employed in primary care settings, highlighting their effectiveness and limitations. Finally, recommendations for future research and practice are discussed to enhance mental health screening and improve outcomes in primary care. Keywords: mental health screening, primary care

Public awareness of warning signs &amp; risk factors of colon cancer &amp; attitude towards screening in primary health care, Riyadh, Saudi Arabia

Objective: This study aimed to assess public awareness of the warning signs and red flags of colon cancer and to evaluate the attitude towards screening for colon cancer. Methods: In this cross-sectional study, the data were gathered from a hard-copy questionnaire. The questionnaire consisted of demographic data and study factor questions. The questionnaire was distributed to 363 participants, either patients or their relatives who visited the primary care clinics in King Abdulaziz Medical City in Riyadh, Saudi Arabia during the period of distribution from June, 2021 to February, 2022. Results: Majority of the participants answered abdominal pain as the common symptom of colon cancer (n = 248, 68.3%) followed by the presence of blood in stool (n = 177, 48.8%). Among the risk factors, inflammatory bowel disease was recognized as the biggest cause (n = 192, 52.9%). There was a statistically significant association between smoking and participants&amp;apos; gender (p-value = 0.018). Conclusions: Public health promotion is important to deliver the knowledge needed to achieve the highest awareness of colorectal cancer. The awareness about colorectal cancer is still not enough, there is gap which needs to be filled with a thorough education about the disease.

Enhancing Provider Mental Health Screening in Primary Care: A Quality Improvement Project.

Background: Depression and anxiety occur in 7.8% and 19.1% of the US population, respectively. About half of those patients are diagnosed in primary care. Objective: The purpose of this quality improvement project was to improve the screening and diagnosing of anxiety and/or depression among adult patients at a primary care clinic by implementing an evidence-based mental health screening interview technique. Methods: The team implemented a mental health screening interview technique that incorporates background, affect, trouble, handling, and empathy and motivational interviewing techniques in addition to self-report surveys. Pre- and post-intervention surveys were conducted to assess providers' perceptions of the new interview technique. ICD-10 code data were gathered to assess the effectiveness of the new mental health screening interview technique. Results: The number of documented diagnoses of single-episode major depressive disorder decreased by 18%, recurrent major depressive disorder increased by 34%, and anxiety disorders increased by 3%. There were more favorable provider perceptions of the new screening interview technique versus the traditional screening method. Conclusions: The results show an improvement in provider comfort and providers preferred the new mental health screening when using an evidence-based mental health screening interview technique. Implications for nursing: The results show the potential benefits of using a structured mental health interview with self-report screening tools when diagnosing anxiety and depression in primary care.

Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care

Health systems in the US are increasingly screening for social determinants of health (SDOH). However, guidance incorporating stakeholder feedback is limited. To examine patient and care team experiences in early implementation of SDOH screening in primary care. This qualitative study included cross-sectional analysis of SDOH screenings during primary care visits from February 22 to May 10, 2022, primary care team member interviews from July 6, 2022, to March 8, 2023, and patient stakeholder engagement on June 30, 2022. The setting was a large southeastern US health care system. Eligible patients were aged 18 years or older with completed visits in primary care. Screening for SDOH in primary care. Multivariable logistic regression evaluated patient (eg, age, race and ethnicity) and care team characteristics (eg, practice type), and screening completeness. Interviews contextualized the quantitative analysis. There were 78 928 visits in practices conducting any SDOH screening. The population with visits had a mean (SD) age of 57.6 (18.1) years; 48 086 (60.9%) were female, 12 569 (15.9%) Black, 60 578 (76.8%) White, and 3088 (3.9%) Hispanic. A total of 54 611 visits (69.2%) were with a doctor of medicine and 13 035 (16.5%) with a nurse practitioner. Most had no SDOH questions answered (75 298 [95.4%]) followed by all questions (2976 [3.77%]). Logistic regression analysis found that clinician type, patient race, and primary payer were associated with screening likelihood: for clinician type, nurse practitioner (odds ratio [OR], 0.13; 95% CI, 0.03-0.62; P = .01) and physician assistant (OR, 3.11; 95% CI, 1.19-8.10; P = .02); for patient race, Asian (OR, 1.69; 95% CI, 1.25-2.28; P = .001); Black (OR, 1.49; 95% CI, 1.10-2.01; P = .009); or 2 or more races (OR, 1.48; 95% CI, 1.12-1.94; P = .006); and for primary payer, Medicaid (OR, 0.62; 95% CI, 0.48-0.80; P < .001); managed care (OR, 1.17; 95% CI, 1.07-1.29; P = .001); uninsured or with Access Health (OR, 0.26; 95% CI, 0.10-0.67; P = .005), and Tricare (OR, 0.71; 95% CI, 0.55-0.92; P = .01). Interview themes included barriers (patient hesitancy, time and resources for screening and referrals, and number of questions/content overlap) and facilitators (communication, practice champions, and support for patient needs). This qualitative study presents potential guidance regarding factors that could improve SDOH screening within busy clinical workflows.

Enhancing Provider Mental Health Screening in Primary Care: A Quality Improvement Project.

Background: Depression and anxiety occur in 7.8% and 19.1% of the US population, respectively. About half of those patients are diagnosed in primary care. Objective: The purpose of this quality improvement project was to improve the screening and diagnosing of anxiety and/or depression among adult patients at a primary care clinic by implementing an evidence-based mental health screening interview technique. Methods: The team implemented a mental health screening interview technique that incorporates background, affect, trouble, handling, and empathy and motivational interviewing techniques in addition to self-report surveys. Pre- and post-intervention surveys were conducted to assess providers' perceptions of the new interview technique. ICD-10 code data were gathered to assess the effectiveness of the new mental health screening interview technique. Results: The number of documented diagnoses of single-episode major depressive disorder decreased by 18%, recurrent major depressive disorder increased by 34%, and anxiety disorders increased by 3%. There were more favorable provider perceptions of the new screening interview technique versus the traditional screening method. Conclusions: The results show an improvement in provider comfort and providers preferred the new mental health screening when using an evidence-based mental health screening interview technique. Implications for nursing: The results show the potential benefits of using a structured mental health interview with self-report screening tools when diagnosing anxiety and depression in primary care.

Changing landscape of paediatric refugee health in South Western Sydney, Australia: a retrospective observational study

ObjectivesTo examine the changing health needs of refugee children and young people (CYP) entering Australia, in relation to key government policy changes.Study designRetrospective analysis of health service use data over...

Factors associated with the identification of mental health conditions among people with learning disabilities in primary care: A scoping review

AbstractBackgroundRates of mental health conditions are high among adults with learning disabilities relative to the general population, however research suggests mental health conditions may be missed or under‐identified in this population group. This review considers factors associated with the identification of mental health conditions among adults with learning disabilities in primary care.MethodsA scoping review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidance extension for scoping reviews (PRISMA‐ScR) We searched electronic databases (Cinahl, PsychINfo and Medline) for articles published between the years 2000 and 2022. Data were extracted, tabulated and themes were identified.FindingsThe searches identified 3262 articles and 34 met inclusion criteria and were included in the review. Six broad themes were identified including (i) mental health screening in primary care, (ii) education, training and awareness raising for primary care staff, (iii) increasing access to psychological therapies (IAPT) through improved mental health condition case recognition in primary care and IAPT practitioner confidence, (iv) health checks and continuity of care, (v) specialist support for primary care providers, and (vi) awareness raising among adults with learning disabilities.ConclusionsThere should be efforts to increase availability in primary care of mental health screening measures suitable for people with learning disabilities. Training opportunities for providers across different sectors of health and social care pathways, on the mental health needs of people with a learning disability are also required. The findings can be used to guide the development of services, for adults with learning disabilities and symptoms of mental health conditions in primary care.

Editorial introductions.

Editorial introductions.

Barriers and facilitators to cognitive impairment screening among older adults with diabetes mellitus and hypertension by primary healthcare providers in rural Uganda.

The burden of non-communicable diseases and cognitive impairment exhibit a linear rise in sub-Saharan Africa due to the increase in life expectancy. Non-communicable diseases like diabetes mellitus and hypertension increase the risk for cognitive impairment. To improve our understanding of the underpinnings of the cognitive impairment screening, this study explored the barriers and facilitators of routine cognitive impairment screening in a primary healthcare setting guided by the Capacity, Opportunity, Motivation Behavioral change (COM-B) model. This was a descriptive qualitative study with primary healthcare providers who provide care to older adults with diabetes mellitus and hypertension at three primary healthcare centers in Mbarara district southwestern Uganda. In-depth interviews were conducted using a semi structured interview guide. Interviews were audio-recorded, transcribed verbatim, and analyzed using the framework approach along the COM-B components. Each COM-B component factors were categorized as barriers and facilitators. We conducted 20 in-depth interviews with clinical officers, enrolled nurses, and a psychiatric nurse. The questions were guided by the Capacity, Opportunity and Motivation Behavioral change (COM-B) framework to identify barriers and facilitators to cognitive impairment screening. The factors that negatively affected the screening were considered as barriers, while the positive as facilitators. Capacity related barriers to cognitive impairment screening included chronic understaffing, primary healthcare provider non-involvement, lack of training/skills, lack of knowledge and awareness in screening, absence of caretakers, lack of patient awareness of cognitive problems; while facilitators were staff recruitment, primary healthcare provider involvement, and specialized training. Opportunity related barriers to screening included patient overload, infrastructure shortage, and time constraints. Motivation related barriers included lack of screening guidance and policy, while the facilitators were availability of mentorship programs for primary healthcare providers. Integrating cognitive impairment screening in primary health care requires engagement of relevant stakeholders with the focus on addressing implementation challenges through capacity development. Timely cognitive impairment screening at the first point of care initiates a cascade of interventions for timely enrollment into care, thus arresting the progress of cognitive impairment that leads to dementia.

Editorial introduction

Editorial introduction

Improving interaction of primary health care facilities and narcological service to provide care to patients with riskу, harmful use or dependency from alcohol or other psychoactive substances

This article provides description of the existing regulatory framework for interaction between medical organizations that provide health to people with risky, hazardous (harmful) use of alcohol or other psychoactive substances in the Russian Federation.Aim. Exploring existing opportunities to improve interaction of primary health care institutions and narcological service to provide care to patients with risky use, harmful use or dependence on psychoactive substances.Materials and methods. The article presents results of implementing the action plan to organize medical prevention in 71 regions of the Russian Federation, based on data provided by chief narcologists of these regions during 2017–2018. The analysis of the existing practice of the interaction of medical institutions for the prevention of the harmful use of psychoactive substances was carried out; were studied the principles of organizing screening and preventive counseling in primary health care; the features of training and education of specialists of medical organizations in the methodology of screening, preventive and motivational counseling were studied in different regions of the Russian Federation.Discussion. During 2017–2018 more than 14.5 million patients were screened in primary health care. Problems alcohol and other psychoactive substances use were identified in more than 300,000 patients (2.4 %). The highest rates of identified substance use disorders’ risks were observed in primary specialized medical care settings (5.1 %); lower rates were observed among those who were undergoing screening in primary health care settings (1.8 %), during preventive health assessment (2.3 %) and during preventive medical check-ups (2.4 %). More than 19,000 health workers have been trained in motivational counseling techniques.Conclusion. The problem of substance abuse and related medical and social consequences remains highly relevant, and therefore requires further implementation of preventive technologies with proven effectiveness.

Improving Diabetic Neuropathy Screening in Primary Health Care: a proposal

Improving Diabetic Neuropathy Screening in Primary Health Care: a proposal

Editorial introductions.

Editorial introductions.

Lung cancer screening in the healthcare system of Bosnia and Herzegovina.

Lung cancer incidence in Bosnia and Hercegovina is high. The implementation of evidence-based lung cancer screening based on low-dose computed tomography (LDCT) may detect lung cancer early and decrease mortality specific to lung cancer. However, LDCT receipt may be unsatisfactory in Europe due to a low distribution of scanners and radiologists or poor access to care. In this paper, we propose a framework for the implementation of lung cancer screening in primary healthcare of Bosnia and Herzegovina based on the United States Preventative Services Task Force recommendation from 2021 and the American College of Radiology Lung CT Screening Reporting & Data System from 2022.