Idowu Omowumi, Sebastianski Meghan, Kung Janice Y, Yuksel Nese, Schindel Theresa J, Tsuyuki Ross T, So Randy, Makhinova Tatiana
Rexall Pharmacies ULC, Mississauga, Ontario.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta.
Can Pharm J (Ott). 2024 Oct 15;157(6):290-303. doi: 10.1177/17151635241284802. eCollection 2024 Nov-Dec.
Early detection of chronic obstructive pulmonary disease (COPD) is a strategy to address the increasing human and economic costs of this condition. This study aimed to inform pharmacists' case-finding strategies by providing an overview of case-finding approaches by health care practitioners.
A scoping review was conducted based on the Joanna Briggs Institute and the PRISMA Extension for Scoping Reviews (PRISMA ScR) guidelines. Included studies were analyzed under the following themes: population characteristics, inclusion and exclusion criteria, setting, case-finding strategies and yield, health care practitioners involved, interprofessional collaboration and the provision of preventive services. Studies were then characterized by highest yields (the weighted average of each approach expressed as a percentage of the total number of new COPD cases divided by the total number of patients screened using the same approach).
The screening process produced 170 eligible studies. Twenty case-finding approaches with average yields of new COPD cases ranging from 3.8% to 29% were identified. The approach with the highest yield involved the use of a questionnaire, peak flow meter and pre-post spirometry. In 14 of these approaches, the process was initiated with the use of questionnaires. In many of the studies, case-finding was targeted at high-risk and/or symptomatic patients. Characteristics of studies with the highest case-finding yields included provider education/training, patient education, active screening, multistep approaches to case-finding, provider engagement, diagnostic criteria by guidelines and engagement of other health care practitioners.
In our scoping review of case-finding methods for patients with COPD, we found the greatest yield from pre-post spirometry following initial screening with a peak flow meter and questionnaire. Pharmacists and health researchers can use these approaches to identify high-risk patients for interventions.
早期发现慢性阻塞性肺疾病（COPD）是应对该疾病日益增加的人力和经济成本的一项策略。本研究旨在通过概述医疗保健从业者的病例发现方法，为药剂师的病例发现策略提供参考。
根据乔安娜·布里格斯研究所和范围综述的PRISMA扩展版（PRISMA ScR）指南进行了一项范围综述。纳入的研究在以下主题下进行分析：人群特征、纳入和排除标准、环境、病例发现策略和产出、参与的医疗保健从业者、跨专业协作以及预防服务的提供。然后根据最高产出（每种方法的加权平均值，表示为新COPD病例总数除以使用相同方法筛查的患者总数的百分比）对研究进行特征描述。
筛选过程产生了170项符合条件的研究。确定了20种病例发现方法，新COPD病例的平均产出率在3.8%至29%之间。产出率最高的方法包括使用问卷、峰值流量计和前后肺活量测定法。在这些方法中的14种中，过程始于问卷的使用。在许多研究中，病例发现针对高危和/或有症状的患者。病例发现产出率最高的研究的特征包括提供者教育/培训、患者教育、主动筛查、多步骤病例发现方法、提供者参与、指南诊断标准以及其他医疗保健从业者的参与。
在我们对COPD患者病例发现方法的范围综述中，我们发现先用峰值流量计和问卷进行初步筛查，然后进行前后肺活量测定法，产出率最高。药剂师和健康研究人员可以使用这些方法来识别需要干预的高危患者。
