Clinical utility of a blood-based protein assay to increase screening of elevated-risk patients for colorectal cancer in the primary care setting

2017 ◽  
Vol 143 (11) ◽  
pp. 2301-2307 ◽  
Author(s):  
John Peabody ◽  
David Paculdo ◽  
Eric Swagel ◽  
Steven Fugaro ◽  
Mary Tran
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Clinical Utility ◽  
Care Setting ◽  
Primary Care Setting ◽  
Elevated Risk ◽  
Protein Assay ◽  
Risk Patients

scholarly journals P0842MANAGEMENT OF RENAL RISK PATIENTS AND THERAPEUTIC CHANGES AFTER DIAGNOSIS OF KIDNEY DISEASE IN PRIMARY CARE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Emanuel Zitt ◽  
Hannelore Sprenger-Mähr ◽  
Karl Lhotta
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
High Risk ◽  
Kidney Disease ◽  
Statin Therapy ◽  
Care Setting ◽  
Primary Care Setting ◽  
Pressure Control ◽  
Risk Patients ◽  
Ras Blockers

Abstract Background and Aims Screening for chronic kidney disease (CKD) is proposed in high risk groups. Whether a new CKD diagnosis in general practice leads to improved patient management, is largely unknown. Method To answer this question and evaluate the kidney disease specific pharmacological care in renal risk patients, a screening study in patients at high risk for kidney disease was performed in the primary care setting in ten general practices in the state of Vorarlberg, Austria. General practitioners were provided with guidelines for the management of CKD with a focus on blood pressure control, RAS inhibition and use of statins. Results In total, 434 patients between age 35 and 77 were included (61% males, mean age 56±7 years, eGFR 86±15 ml/min, body mass index 31±6 kg/m, blood pressure 135±16/83±10 mmHg), of whom 80% had hypertension, 43% had diabetes and 42% were obese. RAS-blockers were already taken by 64% of patients, statins by 39%. A diagnosis of CKD (stage ≥G3 and/or ≥A2) was established in 73 patients (17%), 60% of them had diabetes. Compared to patients without CKD, CKD patients were already treated more often with RAS-blockers (78% vs 61%, p=0.005), whereas statin usage was comparable (44% vs 38%, p=0.3347). After CKD diagnosis, medical therapy was changed in 13 patients (18%). A RAS-blocker was initiated in two out of the 16 patients without a preexisting RAS-blocker (12.5%), the dosage was increased in one patient. Antihypertensive therapy was intensified adding amlodipine in seven patients (10%), and a statin was begun in six (15%) out of 41 statin-naive patients. In those without CKD after the screening, therapy was changed in 40 patients (11%). Compared to patients with CKD, fewer patients started a statin therapy (5% vs 15%, p=0.012) and were additionally treated with amlodipine (3% vs 10%, p=0.021) to optimize blood pressure control. Conclusion This study shows that in the primary care setting a great proportion of CKD patients are already on RAS-blockers, whereas the prescription rate for statins is low. A diagnosis of CKD led to a moderate increase in statin therapy, which leaves further opportunity for improvement. The reasons for this rather low use of statins in CKD patients need to be determined.

Barriers to Colorectal Cancer Screening in a Primary Care Setting in Turkey

2016 ◽  
Vol 42 (1) ◽  
pp. 101-108 ◽  
Author(s):  
Mustafa Kursat Sahin ◽  
Servet Aker ◽  
Hatice Nilden Arslan
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Care Setting ◽  
Primary Care Setting

A population management system for improving colorectal cancer screening in a primary care setting

2015 ◽  
Vol 22 (3) ◽  
pp. 319-328 ◽  
Author(s):  
Charlotte A. Wu ◽  
Amara L. Mulder ◽  
Adrian H. Zai ◽  
Yuanshan Hu ◽  
Manuela Costa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Management System ◽  
Care Setting ◽  
Primary Care Setting ◽  
Population Management

scholarly journals Pharmacist-Driven Spirometry Screening to Target High-Risk Patients in a Primary Care Setting

2019 ◽  
Vol 10 ◽  
pp. 215013271988971
Author(s):  
Jangus B. Whitner ◽  
Lisa A. Mueller ◽  
Alexa Sevin Valentino
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Care Setting ◽  
Primary Care Setting ◽  
Intervention Site ◽  
High Risk Patients ◽  
Vaccine Recommendations ◽  
Number Of Patients ◽  
Risk Patients ◽  
And Control

Objectives: The primary objective of this study is to determine the effect of proactive pharmacist identification of high-risk patients eligible for diagnostic spirometry testing on the percentage of appropriate spirometry referrals ordered and the percentage of spirometry tests completed in those that qualify. Methods: This prospective study compares spirometry referrals ordered and tests completed between an intervention site and control site within a federally qualified health center (FQHC) where pharmacists provide spirometry services. At both sites, all patients who had a primary care provider (PCP) appointment and qualified for spirometry screening on the designated intervention dates during a 12-week period were included in this study. At the intervention site, the pharmacist recommended a spirometry screening to the PCP prior to identified high-risk patients’ appointments. At both sites, a chart review was completed to determine if referrals were ordered and tests were completed for patients who qualified. Results: The number of patients eligible for diagnostic spirometry testing at the intervention and control sites was 190 (n = 125 vs n = 65, respectively). Among eligible patients, the percentage of referrals ordered was significantly higher at the intervention site (47.2% vs 7.7%, P < .001). Among patients who qualified, completion of spirometry testing was significantly higher in the intervention site (23.2% vs 3.1%, P < .001). Conclusion: Results of this study suggest that pharmacists proactively identifying high-risk patients for spirometry screenings within an FQHC increases appropriate referrals ordered by PCPs and tests completed by high-risk patients. Pharmacists in the primary care setting can aid the PCP in the management of chronic obstructive pulmonary disease through significantly increased spirometry referrals and therapeutic clinical assessments and recommendations. They also can provide face-to-face motivational counseling for smoking cessation, inhaler education, and vaccine recommendations. This population health approach to spirometry testing represents an emerging role for pharmacists and could be adopted in other primary care settings.

scholarly journals Managing acute pulmonary embolism in primary care in a patient declining emergency department transfer: a case report

2020 ◽  
Vol 4 (5) ◽  
pp. 1-4 ◽  
Author(s):  
David R Vinson ◽  
Dayna J Isaacs ◽  
Elizabeth J Johnson
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Outpatient Care ◽  
Acute Pulmonary Embolism ◽  
Care Setting ◽  
Primary Care Setting ◽  
Low Risk ◽  
Outpatient Management ◽  
Risk Patients ◽  
Acute Pe

Abstract Background For patients with acute pulmonary embolism (PE) diagnosed in the primary care setting, transfer to a higher level of care, like the emergency department, has long been the convention. Evidence is growing that outpatient management, that is, care without hospitalization, is safe, effective, and feasible for selected low-risk patients with acute PE. Whether outpatient care can be provided entirely in the primary care setting has not been well-studied. We report a case of outpatient management of a low-risk patient with acute PE without emergency department transfer. Case summary A 74-year-old woman with a history of recent surgery and immobilization presented to a primary care physician with 10 days of mild, non-exertional pleuritic chest pain. Her D-dimer concentration was elevated. Computed tomography pulmonary angiography identified a lobar embolus without right ventricular dysfunction. She declined emergency department transfer but was classified as low risk (class II) on the PE Severity Index and met the criteria of the European Society of Cardiology (ESC) for outpatient care. Her physician provided comprehensive clinic-based PE management, discharging her to home with education, anticoagulation, and close follow-up. She completed her 3-month treatment course without complication. Discussion This case describes patient-centred, comprehensive, outpatient PE management in the primary care setting for a woman meeting explicit ESC outpatient criteria. This case illustrates the elements of care that clinics can put in place to facilitate PE management without having to transfer eligible low-risk patients to a higher level of care.

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