scholarly journals Using routinely collected primary care records to identify and investigate severe asthma: a scoping review

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Jonathan Stewart ◽  
Frank Kee ◽  
Nigel Hart
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Severe Asthma ◽  
Scoping Review ◽  
Asthma Severity ◽  
Data Sources ◽  
Full Potential ◽  
High Risk Disease ◽  
Asthma Outcomes ◽  
Disease Variant

AbstractShielding during the coronavirus pandemic has highlighted the potential of routinely collected primary care records to identify patients with ‘high-risk’ conditions, including severe asthma. We aimed to determine how previous studies have used primary care records to identify and investigate severe asthma and whether linkage to other data sources is required to fully investigate this ‘high-risk’ disease variant. A scoping review was conducted based on the Arksey and O’Malley framework. Twelve studies met all criteria for inclusion. We identified variation in how studies defined the background asthma cohort, asthma severity, control and clinical outcomes. Certain asthma outcomes could only be investigated through linkage to secondary care records. The ability of primary care records to represent the entire known asthma population is unique. However, a number of challenges need to be overcome if their full potential to accurately identify and investigate severe asthma is to be realised.

scholarly journals Learning health systems in primary care: a systematic scoping review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Danielle M. Nash ◽  
Zohra Bhimani ◽  
Jennifer Rayner ◽  
Merrick Zwarenstein
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health Systems ◽  
Scoping Review ◽  
Early Stage ◽  
Point Of Care ◽  
The United States ◽  
Stage Of Development ◽  
Integrated Health ◽  
Google Search

Abstract Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

scholarly journals Approaches for combining primary care electronic health record data from multiple sources: a systematic review of observational studies

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037405
Author(s):  
Daniel Dedman ◽  
Melissa Cabecinha ◽  
Rachael Williams ◽  
Stephen J W Evans ◽  
Krishnan Bhaskaran ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Electronic Health Record ◽  
Observational Studies ◽  
Meta Analysis ◽  
Data Sources ◽  
Health Record ◽  
Two Stage ◽  
One Stage ◽  
Electronic Health

ObjectiveTo identify observational studies which used data from more than one primary care electronic health record (EHR) database, and summarise key characteristics including: objective and rationale for using multiple data sources; methods used to manage, analyse and (where applicable) combine data; and approaches used to assess and report heterogeneity between data sources.DesignA systematic review of published studies.Data sourcesPubmed and Embase databases were searched using list of named primary care EHR databases; supplementary hand searches of reference list of studies were retained after initial screening.Study selectionObservational studies published between January 2000 and May 2018 were selected, which included at least two different primary care EHR databases.Results6054 studies were identified from database and hand searches, and 109 were included in the final review, the majority published between 2014 and 2018. Included studies used 38 different primary care EHR data sources. Forty-seven studies (44%) were descriptive or methodological. Of 62 analytical studies, 22 (36%) presented separate results from each database, with no attempt to combine them; 29 (48%) combined individual patient data in a one-stage meta-analysis and 21 (34%) combined estimates from each database using two-stage meta-analysis. Discussion and exploration of heterogeneity was inconsistent across studies.ConclusionsComparing patterns and trends in different populations, or in different primary care EHR databases from the same populations, is important and a common objective for multi-database studies. When combining results from several databases using meta-analysis, provision of separate results from each database is helpful for interpretation. We found that these were often missing, particularly for studies using one-stage approaches, which also often lacked details of any statistical adjustment for heterogeneity and/or clustering. For two-stage meta-analysis, a clear rationale should be provided for choice of fixed effect and/or random effects or other models.

scholarly journals Assessing the clinical utility of genetic risk scores for targeted cancer screening

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Carly A. Conran ◽  
Zhuqing Shi ◽  
William Kyle Resurreccion ◽  
Rong Na ◽  
Brian T. Helfand ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
High Risk ◽  
Risk Score ◽  
Genetic Risk ◽  
Clinical Utility ◽  
Low Risk ◽  
Risk Scores ◽  
Average Risk ◽  
Genetic Risk Scores

Abstract Background Genome-wide association studies have identified thousands of disease-associated single nucleotide polymorphisms (SNPs). A subset of these SNPs may be additively combined to generate genetic risk scores (GRSs) that confer risk for a specific disease. Although the clinical validity of GRSs to predict risk of specific diseases has been well established, there is still a great need to determine their clinical utility by applying GRSs in primary care for cancer risk assessment and targeted intervention. Methods This clinical study involved 281 primary care patients without a personal history of breast, prostate or colorectal cancer who were 40–70 years old. DNA was obtained from a pre-existing biobank at NorthShore University HealthSystem. GRSs for colorectal cancer and breast or prostate cancer were calculated and shared with participants through their primary care provider. Additional data was gathered using questionnaires as well as electronic medical record information. A t-test or Chi-square test was applied for comparison of demographic and key clinical variables among different groups. Results The median age of the 281 participants was 58 years and the majority were female (66.6%). One hundred one (36.9%) participants received 2 low risk scores, 99 (35.2%) received 1 low risk and 1 average risk score, 37 (13.2%) received 1 low risk and 1 high risk score, 23 (8.2%) received 2 average risk scores, 21 (7.5%) received 1 average risk and 1 high risk score, and no one received 2 high risk scores. Before receiving GRSs, younger patients and women reported significantly more worry about risk of developing cancer. After receiving GRSs, those who received at least one high GRS reported significantly more worry about developing cancer. There were no significant differences found between gender, age, or GRS with regards to participants’ reported optimism about their future health neither before nor after receiving GRS results. Conclusions Genetic risk scores that quantify an individual’s risk of developing breast, prostate and colorectal cancers as compared with a race-defined population average risk have potential clinical utility as a tool for risk stratification and to guide cancer screening in a primary care setting.

scholarly journals Ventilation heterogeneity in children with severe asthma

2021 ◽  
Author(s):  
Amy G. Nuttall ◽  
Caroline S. Beardsmore ◽  
Erol A. Gaillard
Keyword(s):  
Severe Asthma ◽  
Airway Disease ◽  
Asthma Severity ◽  
Small Airway ◽  
Cross Sectional ◽  
Lung Clearance ◽  
Moderate Asthma ◽  
Lung Clearance Index ◽  
Children With Asthma ◽  
Ventilation Heterogeneity

AbstractSmall airway disease, characterised by ventilation heterogeneity (VH), is present in a subgroup of patients with asthma. Ventilation heterogeneity can be measured using multiple breath washout testing. Few studies have been reported in children. We studied the relationship between VH, asthma severity, and spirometry in a cross-sectional observational cohort study involving children with stable mild-moderate and severe asthma by GINA classification and a group of healthy controls. Thirty-seven participants aged 5–16 years completed multiple breath nitrogen washout (MBNW) testing (seven controls, seven mild-moderate asthma, 23 severe asthma). The lung clearance index (LCI) was normal in control and mild-moderate asthmatics. LCI was abnormal in 5/23 (21%) of severe asthmatics. The LCI negatively correlated with FEV1z-score.Conclusion: VH is present in asthmatic children and appears to be more common in severe asthma. The LCI was significantly higher in the cohort of children with severe asthma, despite no difference in FEV1 between the groups. This supports previous evidence that LCI is a more sensitive marker of airway disease than FEV1. MBNW shows potential as a useful tool to assess children with severe asthma and may help inform clinical decisions. What is Known:• Increased ventilation heterogeneity is present in some children with asthma• Spirometry is not sensitive enough to detect small airway involvement in asthma What is New• Lung clearance index is abnormal in a significant subgroup of children with severe asthma but rarely in children with mild-moderate asthma• Our data suggests that LCI monitoring should be considered in children with severe asthma

scholarly journals 24-Months Cluster-Randomized Intervention Trial of a Targeted Fall Prevention Program in a Primary Care Setting

2021 ◽  
Author(s):  
Christian Hentschke ◽  
Martin Halle ◽  
Barbara Geilhof ◽  
Peter Landendoerfer ◽  
Wolfgang Blank ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Fall Prevention ◽  
Care Setting ◽  
Primary Care Setting ◽  
Fear Of Falling ◽  
Community Dwelling ◽  
Risk Of Falling ◽  
Injurious Falls ◽  
Cluster Randomized

Abstract Background Falls and fall-related injuries are common in community-dwelling older persons. Longitudinal data on effective fall prevention programs are rare. Objective Therefore, we evaluated a 4-months multi-component exercise fall prevention program in a primary care setting on long-term effects over 24 months on falls and concomitant injuries in older community-dwelling persons with high risk of falling. Design and Setting In the Prevention of Falls (PreFalls) study, forty general practitioners in Germany were cluster-randomized (1:1) into an intervention group (IG) or control group (CG). Three hundred seventy-eight independently living people with high risk of falling (78.1 ± 5.9 years, 75% women) were assigned to IG (n = 222) or CG (n = 156). Intervention and Measurements Patients in IG took part in a 4-months multi-component exercise program comprising strength and balance exercises (28 sessions); patients in CG received no intervention. Primary outcome measure was number of falls over 24 months, analyzed by a patient-level, linear mixed Poisson model. Secondary endpoints were number of fall-related injuries, changes in physical function, fear of falling, and mortality. Results After 24 months, the IG demonstrated significantly fewer falls (IRR = 0.63, p = 0.021), injurious falls (IRR = 0.69, p = 0.034), and less fear of falling (p = 0.005). The mortality rate was 5.0% in IG and 10.3% in CG (HR = 0.51, 95% CI: 0.24 to 1.12; p = 0.094). Conclusions In older community-dwelling persons with high risk of falling, a short-term multi-component exercise intervention reduced falls and injurious falls, as well as fear of falling over 24 months.

Behavioral and biologic evidence of persistent high-risk behavior in an HIV primary care population

AIDS ◽  
2000 ◽  
Vol 14 (3) ◽  
pp. 297-301 ◽  
Author(s):  
Emily J. Erbelding ◽  
David Stanton ◽  
Thomas C. Quinn ◽  
Anne Rompalo
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Risk Behavior ◽  
High Risk Behavior ◽  
Primary Care Population ◽  
Hiv Primary Care
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