scholarly journals Accuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among primary care patients (≥40 years) in China: a cross-sectional screening test accuracy study: findings from the Breathe Well group

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e051811
Author(s):  
Zihan Pan ◽  
Andrew P Dickens ◽  
Chunhua Chi ◽  
Xia Kong ◽  
Alexandra Enocson ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Screening Test ◽  
Peak Flow ◽  
Screening Tests ◽  
Test Accuracy ◽  
Reference Test ◽  
Community Health Centres ◽  
Health Centres ◽  
Accuracy Study

ObjectivesTo examine the accuracy and cost-effectiveness of various chronic obstructive pulmonary disease (COPD) screening tests and combinations within a Chinese primary care population.DesignScreening test accuracy study.SettingUrban and rural community health centres in four municipalities of China: Beijing (north), Chengdu (southwest), Guangzhou (south) and Shenyang (northeast).ParticipantsCommunity residents aged 40 years and above who attended community health centres for any reason were invited to participate. 2445 participants (mean age 59.8 (SD 9.6) years, 39.1% (n=956) male) completed the study (February–December 2019), 68.9% (n=1684) were never-smokers and 3.6% (n=88) had an existing COPD diagnosis. 13.7% (n=333) of participants had spirometry-confirmed airflow obstruction.InterventionsParticipants completed six index tests (screening questionnaires (COPD Diagnostic Questionnaire, COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE), Chinese Symptom-Based Questionnaire (C-SBQ), COPD-SQ), microspirometry (COPD-6), peak flow (model of peak flow meters used in the study (USPE)) and the reference test (ndd Easy On-PC).Primary and secondary outcomesCases were defined as those with forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) below the lower limit of normal (LLN-GLI) on the reference test. Performance of individual screening tests and their combinations was evaluated, with cost-effectiveness analyses providing cost per additional true case detected.ResultsAirflow measurement devices (sensitivities 64.9% (95% CI 59.5% to 70.0%) and 67.3% (95% CI 61.9% to 72.3%), specificities 89.7% (95% CI 88.4% to 91.0%) and 82.6% (95% CI 80.9% to 84.2%) for microspirometry and peak flow, respectively) generally performed better than questionnaires, the most accurate of which was C-SBQ (sensitivity 63.1% (95% CI 57.6% to 68.3%) specificity 74.2% (95% CI 72.3% to 76.1%)). The combination of C-SBQ and microspirometry used in parallel maximised sensitivity (81.4%) (95% CI 76.8% to 85.4%) and had specificity of 68.0% (95% CI 66.0% to 70.0%), with an incremental cost-effectiveness ratio of £64.20 (CNY385) per additional case detected compared with peak flow.ConclusionsSimple screening tests to identify undiagnosed COPD within the primary care setting in China is possible, and a combination of C-SBQ and microspirometry is the most sensitive and cost-effective. Further work is required to explore optimal cut-points and effectiveness of programme implementation.Trial registration numberISRCTN13357135.

scholarly journals Aeroallergen sensitisation for detecting asthma in primary care: a diagnostic test accuracy study

2021 ◽  
Author(s):  
Janwillem W.H. Kocks ◽  
Heinze J.H. Andringa ◽  
Ellen van Heijst ◽  
Renaud Louis ◽  
Inigo Ojanguren Arranz ◽  
...  
Keyword(s):  
Primary Care ◽  
Diagnostic Test ◽  
Diagnostic Test Accuracy ◽  
Test Accuracy ◽  
Accuracy Study

scholarly journals The development of urban community health centres for strengthening primary care in China: a systematic literature review

2015 ◽  
pp. ldv043 ◽  
Author(s):  
Harry H. X. Wang ◽  
Jia Ji Wang ◽  
Samuel Y. S. Wong ◽  
Martin C. S. Wong ◽  
Stewart W. Mercer ◽  
...  
Keyword(s):  
Primary Care ◽  
Literature Review ◽  
Community Health ◽  
Systematic Literature Review ◽  
Urban Community ◽  
Community Health Centres ◽  
Health Centres

scholarly journals Attributes of primary care in community health centres in China and implications for equitable care: a cross-sectional measurement of patients' experiences

QJM ◽  
2014 ◽  
Vol 108 (7) ◽  
pp. 549-560 ◽  
Author(s):  
H. H. X. Wang ◽  
S. Y. S. Wong ◽  
M. C. S. Wong ◽  
J. J. Wang ◽  
X. L. Wei ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Cross Sectional ◽  
Community Health Centres ◽  
Health Centres ◽  
Sectional Measurement

Community Health and General Practice: The Impact of Different Cultures on the Integration of Primary Care

2001 ◽  
Vol 7 (1) ◽  
pp. 65 ◽  
Author(s):  
Hal Swerissen ◽  
Jenny Macmillan ◽  
Catuscia Biuso ◽  
Linda Tilgner
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Community Health ◽  
Community Health Centres ◽  
Care Services ◽  
Primary Health ◽  
Health Centres ◽  
The Relationship

This study examined the existing relationship between community health centres and General Practice Divisions in the State of Victoria, including the nature of joint working arrangements and the identification of barriers to greater collaboration. Improved integration of primary health care services has been advocated to improve consumer and population health outcomes and to reduce inappropriate use of acute and extended care services. General practitioners (GPs) and community health centres are two key providers of primary health care with potential for greater integration. The current study conducted telephone interviews with 20 community health centre CEOs and 18 Executive Officers of divisions, which were matched according to catchment boundaries. Results suggest, while some joint planning is occurring, especially on committees, working parties and projects, there is an overall low level of satisfaction with the relationship between community health centres and GPs and GP divisions. Major barriers to greater integration are the financial or business interests of GPs and misunderstanding and differences in perceived roles and ideology between GPs and community health centres. Improved communication, greater contact and referral and follow-up procedures are identified as a means of improving the relationship between GPs, GP divisions and community health centres. Community health centres and general practitioners (GPs) are key providers of primary care (Australian Community Health Association, 1990).

scholarly journals Primary care providers’ beliefs and practices on colorectal cancer screening in Kuwait

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
E L Tolma ◽  
S M Aljunid ◽  
M N Amrizal ◽  
J Longenecker ◽  
A Al-Basmy ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Health System ◽  
Screening Test ◽  
Primary Care Providers ◽  
Screening Tests ◽  
Care Providers ◽  
Beliefs And Practices ◽  
Crc Screening

Abstract Background Colorectal cancer (CRC) is a major public health issue in the Arab region. In Kuwait, CRC is the second most frequent cancer, with an age-standardized (world) incidence rate of 13.2 cases/100,000 in 2018. Despite the national efforts to promote CRC screening the current participation rate is very low (5 to 17%). Primary Care Providers (PCPs) are considered as the gatekeepers of cancer screening globally. This is one of the first studies in Kuwait that examined the current beliefs/practices of PCPs on CRC screening. Methods This cross-sectional study was conducted at governmental primary care centers in Kuwait from 2015-2017. Of 564 PCPs invited to participate from all centers, 255 completed the self-administered questionnaires. The 14-page survey contained 75 questions on PCPs’ beliefs and practices of CRC screening. Data were analyzed by using descriptive statistics. Results The study sample consisted primarily of females (52.0%) and non-Kuwaiti (79%) physicians, with mean age =43.3 (SD: 11.2) years. Most respondents (92%) believed that colonoscopy is the most effective screening tool. The majority (78%) reported that they recommend CRC screening to their patients, with colonoscopy as the most frequent modality (87%) followed by the Faecal Occult Blood Test (FOBT) (52%). Around 40% of the respondents stated that they did not have time to discuss CRC screening with their patients. The majority (72%) believed that their patients did not complete their CRC screening tests. Health system related barriers included difficulties in obtaining test results from the gastroenterologist (61.4%), ordering follow-up test after a positive screening test (50.6%) and shortage of trained staff to conduct the screening test (44.2%). Conclusions A majority of PCPs in Kuwait recommend CRC screening to their patients, but not all patients follow through their recommendation. More research is needed to find out how to further enhance patient uptake of CRC screening. Key messages Colonoscopy is the most frequent screening CRC modality used in Kuwait. Health system related factors can be important future intervention targets to promote CRC screening.

Pulse oximetry as a screening test for congenital heart defects in newborn infants: the pulseox test accuracy study

2011 ◽  
Vol 96 (Supplement 1) ◽  
pp. Fa3-Fa3
Author(s):  
L. J. Middleton ◽  
A. K. Ewer ◽  
A. Bhoyar ◽  
A. T. Furmston ◽  
J. P. Daniels ◽  
...  
Keyword(s):  
Pulse Oximetry ◽  
Congenital Heart Defects ◽  
Screening Test ◽  
Congenital Heart ◽  
Heart Defects ◽  
Newborn Infants ◽  
Test Accuracy ◽  
Accuracy Study

scholarly journals A Meta-analysis of Clinical Screening Tests for Obstructive Sleep Apnea

2009 ◽  
Vol 110 (4) ◽  
pp. 928-939 ◽  
Author(s):  
Satya Krishna Ramachandran ◽  
Lydia A. Josephs
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Screening Test ◽  
Meta Analysis ◽  
False Negative ◽  
Significant Proportion ◽  
Screening Tests ◽  
Test Accuracy ◽  
Clinical Screening ◽  
Obstructive Sleep

The purpose of this meta-analysis is to compare clinical screening tests for obstructive sleep apnea and establish an evidence base for their preoperative use. Diagnostic odds ratios were used as summary measures of accuracy, and false-negative rates were used as measures of missed diagnosis with each screening test in this review. Metaregression revealed that clinical models, logarithmic equations, combined techniques, cephalometry, and morphometry are significant characteristics, whereas body mass index, history of hypertension, and nocturnal choking are significant test elements associated with higher diagnostic accuracy. Test accuracy in repeated validation studies of the same screening test is variable, suggesting an underlying heterogeneity in either the clinical presentation of obstructive sleep apnea or the measured clinical elements of these models. Based on the false-negative rates, it is likely that most of the clinical screening tests will miss a significant proportion of patients with obstructive sleep apnea.

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