Strategies for screening for familial hypercholesterolaemia in primary care and other community settings

Abstract Background Primary care physicians (PCP) play an important role in detecting Familial Hypercholesterolaemia (FH) early. However, knowledge, awareness and practice (KAP) regarding FH among Malaysian PCP are not well established, and there was no validated tool to assess their FH KAP. Thus, the aim of this study was to adapt an FH KAP questionnaire and determine its validity and reliability among Malaysian PCP. Methods This cross-sectional validation study involved Malaysian PCP with ≥ 1-year work experience in the primary care settings. In Phase 1, the original 19-item FH KAP questionnaire underwent content validation and adaptation by 7 experts. The questionnaire was then converted into an online survey instrument and was face validated by 10 PCP. In Phase 2, the adapted questionnaire was disseminated through e-mail to 1500 PCP. Data were collected on their KAP, demography, qualification and work experience. The construct validity was tested using known-groups validation method. The hypothesis was PCP holding postgraduate qualification (PCP-PG-Qual) would have better FH KAP compared with PCP without postgraduate qualification (PCP-noPG-Qual). Internal consistency reliability was calculated using Kuder Richardson formula-20 (KR-20) and test–retest reliability was tested on 26 PCP using kappa statistics. Results During content validation and adaptation, 10 items remained unchanged, 8 items were modified, 1 item was moved to demography and 7 items were added. The adapted questionnaire consisted of 25 items (11 knowledge, 5 awareness and 9 practice items). A total of 130 out of 1500 PCP (response rate: 8.7%) completed the questionnaire. The mean percentage knowledge score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (53.5, SD ± 13.9 vs. 35.9, SD ± 11.79), t(128) = 6.90, p < 0.001. The median percentage awareness score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (15.4, IqR ± 23.08 vs. 7.7, IqR ± 15.38), p = 0.030. The mean percentage practice score was significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (69.2, SD ± 17.62 vs. 54.4, SD ± 19.28), t(128) = 3.79, p < 0.001. KR-20 value was 0.79 (moderate reliability) and average Kappa was 0.796 (substantial agreement). Conclusion This study has proven that the 25-item adapted FH KAP questionnaire is valid and reliable. It can be used to measure and establish FH KAP among PCP in Malaysia.

Download Full-text

Familial hypercholesterolaemia in primary care: Awareness, knowledge and practices among primary care doctors in Malaysia

Atherosclerosis ◽

10.1016/j.atherosclerosis.2016.07.363 ◽

2016 ◽

Vol 252 ◽

pp. e41 ◽

Cited By ~ 1

Author(s):

A.S. Ramli ◽

N.A. Mohd Mokhsin ◽

S. Abdul Razak ◽

M. Md Yasin ◽

Z. Ismail ◽

...

Keyword(s):

Primary Care ◽

Familial Hypercholesterolaemia ◽

Primary Care Doctors

Download Full-text

Improving risk factor management for patients with poorly controlled type 2 diabetes: a systematic review of healthcare interventions in primary care and community settings

BMJ Open ◽

10.1136/bmjopen-2016-015135 ◽

2017 ◽

Vol 7 (8) ◽

pp. e015135 ◽

Cited By ~ 19

Author(s):

Mark E Murphy ◽

Molly Byrne ◽

Rose Galvin ◽

Fiona Boland ◽

Tom Fahey ◽

...

Keyword(s):

Primary Care ◽

Glycaemic Control ◽

Study Quality ◽

Regression Analyses ◽

Community Settings ◽

Baseline Hba1c ◽

Poor Glycaemic Control ◽

Healthcare Interventions ◽

Meta Analyses

ObjectivesPoorly controlled type 2 diabetes mellitus (T2DM) is a major international health problem. Our aim was to assess the effectiveness of healthcare interventions, specifically targeting patients with poorly controlled T2DM, which seek to improve glycaemic control and cardiovascular risk in primary care settings.DesignSystematic review.SettingPrimary care and community settings.Included studiesRandomised controlled trials (RCTs) targeting patients with poor glycaemic control were identified from Pubmed, Embase, Web of Science, Cochrane Library and SCOPUS. Poor glycaemic control was defined as HbA1c over 59 mmol/mol (7.5%).InterventionsInterventions were classified as organisational, patient-oriented, professional, financial or regulatory.OutcomesPrimary outcomes were HbA1c, blood pressure and lipid control. Two reviewers independently assessed studies for eligibility, extracted data and assessed study quality. Meta-analyses were undertaken where appropriate using random-effects models. Subgroup analysis explored the effects of intervention type, baseline HbA1c, study quality and study duration. Meta-regression analyses were undertaken to investigate identified heterogeneity.ResultsForty-two RCTs were identified, including 11 250 patients, with most undertaken in USA. In general, studies had low risk of bias. The main intervention types were patient-directed (48%) and organisational (48%). Overall, interventions reduced HbA1c by −0.34% (95% CI −0.46% to −0.22%), but meta-analyses had high statistical heterogeneity. Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5% had better improvements in HbA1c. Meta-regression analyses suggested that only interventions on those with population HbA1c over 9.5% were more effective. Interventions had a modest improvement of blood pressure and lipids, although baseline levels of control were generally good.ConclusionsThis review suggests that interventions for T2DM, in primary care, are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective.

Download Full-text

Useful information

Oxford Handbook of Primary Care and Community Nursing ◽

10.1093/med/9780198831822.003.0014 ◽

2020 ◽

pp. 831-844

Keyword(s):

Primary Care ◽

Herbal Medicine ◽

Educational Needs ◽

Alternative Therapies ◽

Assistive Technologies ◽

Faith Healing ◽

Community Settings ◽

Special Educational Needs ◽

Death Certification ◽

Complex Equipment

This chapter provides other useful topics for nurses working in primary care or community settings. It defines telecare and telehealth, assistive technologies (ranging from special educational needs equipment to moving and handling systems) and home adaptations (including complex equipment, methods of hiring or buying disability equipment, and wheelchair services), and complementary and alternative therapies (including acupuncture, aromatherapy, faith healing, herbal medicine, homeopathy, hypnotherapy, osteopathy, chiropractic treatments, and reflexology). It also outlines processes for the verification of the fact of death, certification of death, and the registration of births, marriages, civil partnerships, and deaths.

Download Full-text

Comparison of Outcomes of Glaucoma Screening in Primary Care and Community Settings

Ophthalmic Epidemiology ◽

10.1080/09286586.2019.1626444 ◽

2019 ◽

Vol 26 (5) ◽

pp. 355-359

Author(s):

Adam J. Schettler ◽

Oliver R. Filutowski ◽

Ira M. Helenius ◽

Peter A. Netland

Keyword(s):

Primary Care ◽

Community Settings ◽

Glaucoma Screening

Download Full-text

Interventions for improving outcomes in patients with multimorbidity in primary care and community settings

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd006560.pub3 ◽

2016 ◽

Cited By ~ 89

Author(s):

Susan M Smith ◽

Emma Wallace ◽

Tom O'Dowd ◽

Martin Fortin

Keyword(s):

Primary Care ◽

Community Settings

Download Full-text

Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd001481 ◽

2000 ◽

Cited By ~ 77

Author(s):

Carry Mira Renders ◽

Gerlof D Valk ◽

Simon J Griffin ◽

Edward Wagner ◽

Jacques ThM van Eijk ◽

...

Keyword(s):

Diabetes Mellitus ◽

Primary Care ◽

Community Settings

Download Full-text

Costing Methodology and Key Drivers of Health Care Costs Within Economic Analyses in Musculoskeletal Community and Primary Care Services: A Systematic Review of the Literature

Journal of Primary Care & Community Health ◽

10.1177/2150132719899763 ◽

2020 ◽

Vol 11 ◽

pp. 215013271989976

Author(s):

Roanna Burgess ◽

James Hall ◽

Annette Bishop ◽

Martyn Lewis ◽

Jonathan Hill

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Costs ◽

Community Settings ◽

Outpatient Visits ◽

Key Drivers ◽

Gp Visits ◽

Economic Analyses ◽

Care Costs

Background: Identifying variation in musculoskeletal service costs requires the use of specific standardized metrics. There has been a large focus on costing, efficiency, and standardized metrics within the acute musculoskeletal setting, but far less attention in primary care and community settings. Objectives: To ( a) assess the quality of costing methods used within musculoskeletal economic analyses based primarily in primary and community settings and ( b) identify which cost variables are the key drivers of musculoskeletal health care costs within these settings. Methods: Medline, AMED, EMBASE, CINAHL, HMIC, BNI, and HBE electronic databases were searched for eligible studies. Two reviewers independently extracted data and assessed quality of costing methods using an established checklist. Results: Twenty-two studies met the review inclusion criteria. The majority of studies demonstrated moderate- to high-quality costing methods. Costing issues included studies failing to fully justify the economic perspective, and not distinguishing between short- and long-run costs. Highest unit costs were hospital admissions, outpatient visits, and imaging. Highest mean utilization were the following: general practitioner (GP) visits, outpatient visits, and physiotherapy visits. Highest mean costs per patient were GP visits, outpatient visits, and physiotherapy visits. Conclusion: This review identified a number of key resource use variables that are driving musculoskeletal health care costs in the community/primary care setting. High utilization of these resources (rather than high unit cost) appears to be the predominant factor increasing mean health care costs. There is, however, need for greater detail with capturing these key cost drivers, to further improve the accuracy of costing information.

Download Full-text