scholarly journals Faecal immunochemical test to triage patients with abdominal symptoms for suspected colorectal cancer in primary care: review of international use and guidelines

2020 ◽  
Vol 37 (5) ◽  
pp. 606-615 ◽  
Author(s):  
Marije van Melle ◽  
Samir I S Yep Manzano ◽  
Hugh Wilson ◽  
Willie Hamilton ◽  
Fiona M Walter ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Primary Care Patient ◽  
Care Patient ◽  
Bowel Habit ◽  
Level Of Evidence ◽  
Primary Care Population ◽  
Abdominal Symptoms ◽  
Primary Care Patients ◽  
The Uk

Abstract Background Recently, faecal immunochemical tests (FITs) have been introduced for investigation of primary care patients with low-risk symptoms of colorectal cancer (CRC), but recommendations vary across the world. This systematic review of clinical practice guidelines aimed to determine how FITs are used in symptomatic primary care patients and the underpinning evidence for these guidelines. Methods MEDLINE, Embase and TRIP databases were systematically searched, from 1 November 2008 to 1 November 2018 for guidelines on the assessment of patients with symptoms suggestive of CRC. Known guideline databases, websites and references of related literature were searched. The following questions were addressed: (i) which countries use FIT for symptomatic primary care patients; (ii) in which populations is FIT used; (iii) what is the cut-off level used for haemoglobin in the faeces (FIT) and (iv) on what evidence are FIT recommendations based. Results The search yielded 2433 publications; 25 covered initial diagnostic assessment of patients with symptoms of CRC in 15 countries (Asia, n = 1; Europe, n = 13; Oceania, n = 4; North America, n = 5; and South America, n = 2). In three countries (Australia, Spain and the UK), FIT was recommended for patients with abdominal symptoms, unexplained weight loss, change in bowel habit or anaemia despite a low level of evidence in the symptomatic primary care patient population. Conclusions Few countries recommend FITs in symptomatic patients in primary care either because of limited evidence or because symptomatic patients are directly referred to secondary care without triage. These results demonstrate a clear need for research on FIT in the symptomatic primary care population.

CONUT: a tool to assess nutritional status. First application in a primary care population

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Maria Salinas ◽  
Emilio Flores ◽  
Alvaro Blasco ◽  
Maite López-Garrigós ◽  
Carmen Puche ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Clinical Laboratory ◽  
Primary Care Patient ◽  
Demographic Data ◽  
Health Department ◽  
Care Patient ◽  
Primary Care Population ◽  
Primary Care Patients ◽  
Conut Score

AbstractObjectivesMalnutrition is an unfavorable prognostic factor associated with an increase in mortality, hospital stays, readmissions and resources consumption. The aim was to screen primary care patients for risk of malnutrition by using the control nutritional (CONUT) score, calculated through total lymphocytes count, serum albumin and total cholesterol, when the three markers were requested, and to compare results between primary care centers (PCC).MethodsThe clinical laboratory located in a 370-bed suburban University Community Hospital serves the Health Department inhabitants (2,34,551), attended in nine PCC. The laboratory information system (LIS) automatically calculated the CONUT score in every primary care patient over 18 years old, when all three laboratory markers were ordered by the General Practitioner. For all primary care patients, we collected demographic data, CONUT index and PCC. We classified results by PCC, and compared them.ResultsThe clinical laboratory received 74,743 requests from primary care. The CONUT score was calculated in 7,155 (12.28%) patients. Nine hundred seventy-six (13.6%) were at risk of malnutrition according to the CONUT score, mainly male (p<0.01) and over 65 (p<0.01). Detected cases of malnutrition were all mild, except 48 patients (4.9%) with moderate, and one (0.1%) with severe risk. The percentage of patients at risk of malnutrition was not significantly different among PCC, with the exception of one with patients at lower malnutrition risk.ConclusionsIt is possible to use CONUT score as a front-line population-wide laboratory marker to screen for the risk for malnutrition in primary care patients that was lower in one PCC.

scholarly journals Detection of depression in older adults by family and friends: distinguishing mood disorder signals from the noise of personality and everyday life

2010 ◽  
Vol 23 (4) ◽  
pp. 634-643 ◽  
Author(s):  
Paul R. Duberstein ◽  
Yan Ma ◽  
Benjamin P. Chapman ◽  
Yeates Conwell ◽  
Joanne McGriff ◽  
...  
Keyword(s):  
Primary Care ◽  
Mood Disorder ◽  
Sensitivity And Specificity ◽  
Primary Care Patient ◽  
Structured Interview ◽  
Care Patient ◽  
Primary Care Settings ◽  
Primary Care Patients ◽  
Health Significance ◽  
Neo Five Factor Inventory

ABSTRACTBackground: The capacity of friends and family member informants to make judgments about the presence of a mood disorder history in an older primary care patient has theoretical, clinical, and public health significance. This study examined the accuracy of informant-reported mood disorder diagnoses in a sample of primary care patients aged 65 years or older. We hypothesized that the accuracy (sensitivity and specificity) of informant reports would vary with the patient's personality.Methods: Hypotheses were tested in 191 dyads consisting of patients and their friends or relatives (informants) recruited from primary care settings. Gold-standard mood disorder diagnoses were established at consensus conferences based on a review of medical charts and data collected in a structured interview with the patient. Patients completed an assessment battery that included the NEO-Five Factor Inventory.Results: Sensitivity and specificity of informant-derived mood disorder diagnoses were related to patient personality. Sensitivity of informant-derived lifetime mood disorder diagnoses was compromised by higher Extraversion and higher Agreeableness. Specificity of informant-derived lifetime mood disorder diagnoses was compromised by lower Agreeableness and higher Conscientiousness.Conclusion: Patient personality has implications for the accuracy of mood disorder histories provided by friends and family members. Given that false negatives can have grave consequences, we recommend that practitioners be particularly vigilant when interpreting collateral information about their extraverted, agreeable patients.

scholarly journals A Student Telephone Intervention for Primary Care Patient Safety During the COVID-19 Pandemic

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Joanne E. Wilkinson ◽  
Garrett Bowen ◽  
Jeanette Gonzalez-Wright
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Medical Students ◽  
Primary Care Patient ◽  
Care Patient ◽  
Outreach Program ◽  
Clinical Learning ◽  
Telephone Intervention ◽  
Phone Calls ◽  
Primary Care Patients

Background and Objectives: During the COVID-19 pandemic, medical students were unable to participate in clinical learning for several weeks. Many primary care patients no-showed to appointments and did not receive care. We implemented a telephone outreach program using medical students to call primary care patients who no-showed to appointments and did not receive care. Methods: A brief plan-do-study-act cycle was used to establish protocols and supervision for the phone calls. Results: In the first 5 weeks, of 3,274 scheduled patients there were 426 no-shows; 309 received outreach from students. We developed protocols for supervision, routing, and triage. Conclusion: It is feasible and educationally valuable to collaborate with students to reach patients who are at home due to the pandemic. Other practices could adapt this tool in similar situations.

scholarly journals Integrated primary care: patient perceptions and the role of mental health stigma

2018 ◽  
Vol 20 ◽  
Author(s):  
Lisa R. Miller-Matero ◽  
Shehryar Khan ◽  
Rachel Thiem ◽  
Tiffany DeHondt ◽  
Hala Dubaybo ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Behavioral Health ◽  
Primary Care Patient ◽  
Care Patient ◽  
Integrated Primary Care ◽  
Health Clinic ◽  
Mental Health Stigma ◽  
Primary Care Patients

Abstract Some patients are more willing to see a behavioral health provider within primary care. The purpose of this study was to evaluate the patients’ perspectives of having access to a psychologist within primary care and to investigate whether mental health stigma affected preferences. In total, 36 patients completed questionnaires after seeing a psychologist in primary care. Patients were satisfied with having a primary care psychologist involved in their care. Most patients were more likely to see the psychologist in primary care and those who preferred this indicated higher levels of mental health stigma. The overarching theme for why patients saw a psychologist in primary care was convenience. Mental health stigma may also have played a role. Results suggest that providing integrated services may reach patients who may not have otherwise sought services in a behavioral health clinic. Findings from this study encourage the continued integration of behavioral health services.

scholarly journals Primary prescription adherence for obstructive lung disease in a primary care population

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Alexander G. Singer ◽  
Alan Katz ◽  
Lisa LaBine ◽  
Lisa M. Lix ◽  
Marina Yogendran ◽  
...  
Keyword(s):  
Primary Care ◽  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Primary Care Patient ◽  
Age Groups ◽  
Airway Disease ◽  
Care Patient ◽  
Logistic Regression Models ◽  
Primary Care Population ◽  
Income Quartile

Abstract Background The objective of this study was to determine primary prescription adherence for obstructive lung diseases (e.g., asthma, COPD) in an adult primary care patient population over a 3-year period. Methods A retrospective analysis of electronic medical record and administrative data was performed to determine primary adherence, defined as dispensation of a new prescription within 90 days of the date the prescription was written. Multivariable logistic regression models were used to test predictors of prescription primary adherence. Results Of 13,220 prescriptions for obstructive airway disease, 75.9% (N = 10,038) were filled. In multivariate analysis, depression, certain age groups (18–44 years), higher income quartile were associated with reduced prescription adherence. However, 1–2 ER visits in the previous year (compared to no ER visits), number of ambulatory visits in the previous year, and number of hospitalizations in the previous year, did not increase the likelihood of prescription adherence. Interpretation This study provides important insights about factors associated with prescription nonadherence and is the first study examining primary medication adherence with medications for obstructive lung disease in adults, providing indications of prescription nonadherence patterns among a broad population.

scholarly journals Nature and type of patient-reported safety incidents in primary care: cross-sectional survey of patients from Australia and England

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042551
Author(s):  
Andrea L Hernan ◽  
Sally J Giles ◽  
Andrew Carson-Stevens ◽  
Mark Morgan ◽  
Penny Lewis ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Patient ◽  
Care Patient ◽  
System Level ◽  
Service Improvement ◽  
Cross Sectional ◽  
Positive Effects ◽  
Contributory Factors ◽  
Safety Incident ◽  
Patient Reported

BackgroundPatient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement.ObjectiveThe aim of this study was to characterise the nature of patient-reported safety incidents in primary care.DesignSecondary analysis of two cross sectional studies.ParticipantsAdult patients from Australian and English primary care settings.MeasuresPatients’ self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented.ResultsA total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent.ConclusionsThe nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement.

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