如何利用电子病历和其他数据改善机会性筛查。克罗地亚目标人群中未被发现的糖尿病患病率。

How to improve opportunistic screening by using EMRs and other data. The prevalence of undetected diabetes mellitus in target population in Croatia.

作者信息

Vrca Botica M, Carkaxhiu L, Kern J, Pavlić Renar I, Botica I, Zelić I, Iliev D, Vrca A

机构信息

Department of Family Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia.

Department of Family Medicine, University of Prishtina, Prishtina, Kosovo.

出版信息

Public Health. 2017 Apr;145:30-38. doi: 10.1016/j.puhe.2016.12.008. Epub 2017 Jan 19.

DOI:10.1016/j.puhe.2016.12.008

PMID:28359387

Abstract

OBJECTIVES

Opportunistic screening for type 2 diabetes (T2D) has not been adopted as part of routine practice. The aim of the study was to investigate the yield of opportunistic target screening for T2D in Croatia and to evaluate the process of screening by using data from electronic medical record.

STUDY DESIGN

We conducted opportunistic screening in 23 general practitioners (GPs) in a population of 13,344 patients aged 45-70 years.

METHODS

First, after excluding patients with T2D, patients with risk factors for T2D were derived from the electronic medical record and GP's assessment during the preconsultation phase. Second, those with data about normoglycemia in past three years were excluded. Remaining patients started the consultation phase during their usual visit, when they were offered capillary fasting plasma glucose testing in the next consultation.

RESULTS

Prevalence of T2D was 10.9% (new 1.4%). A total of 5568 (46.1%) patients had risks and 2849 (51.2%) had data about normoglycemia in the last three years. Using those data, number needed to invite to screening (NNI) was reduced to half: from 46.1% to 22.5%. One hundred eighty-four patients were screened positive for T2D in two capillary fasting plasma glucose tests (yield 9.8%). Number needed to screen (NNS) in order to detect one T2D was 10.3 patients. Among risks for T2D, overweight was the best predictive factor for undiagnosed T2D (odds ratio [OR]: 2.11, confidence interval [CI]:1.41-3.15, P < .001). Logistic regression showed that in targeted population, overweight patients with a family history in fold were 2.5 times more likely to have T2D (OR: 2.54, CI 1.78-.61, P < .001).

CONCLUSIONS

Total yield in targeted population was 1,4%. By using data about normoglycemia from EMRs, NNI was reduced by half and NNS was 10.3 patients. Our findings suggest the model for improvement in opportunistic screening.

摘要

目的

机会性筛查2型糖尿病（T2D）尚未被纳入常规医疗实践。本研究旨在调查克罗地亚机会性目标筛查T2D的产出率，并利用电子病历数据评估筛查过程。

研究设计

我们在23名全科医生（GP）中对13344名年龄在45 - 70岁的患者进行了机会性筛查。

方法

首先，排除T2D患者后，从电子病历和预诊阶段全科医生的评估中获取T2D风险因素患者。其次，排除过去三年有血糖正常数据的患者。其余患者在常规就诊时开始咨询阶段，在此期间他们在下一次咨询时接受空腹毛细血管血糖检测。

结果

T2D患病率为10.9%（新发病例1.4%）。共有5568名（46.1%）患者有风险因素，2849名（51.2%）患者在过去三年有血糖正常数据。利用这些数据，需要邀请进行筛查的人数（NNI）减少了一半：从46.1%降至22.5%。在两次空腹毛细血管血糖检测中有184名患者T（2D筛查呈阳性（产出率9.8%）。检测出一例T2D所需的筛查人数（NNS）为10.3名患者。在T2D风险因素中，超重是未诊断T2D的最佳预测因素（比值比[OR]：2.11，置信区间[CI]：1.41 - 3.15，P <.001）。逻辑回归显示，在目标人群中，有家族史的超重患者患T2D的可能性高2.5倍（OR：2.54，CI 1.78 - 6.61，P <.001）。