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Pautrat M, Barbier E, Lebeau JP. Identifying available substance use disorder screening tests feasible for use in primary care: A systematic review. Prev Med Rep 2024; 38:102610. [PMID: 38375183 PMCID: PMC10874871 DOI: 10.1016/j.pmedr.2024.102610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 11/22/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024] Open
Abstract
Substance use disorders substantially contribute to the global burden of disease. Early detection in primary care is recommended, and numerous screening tests are available. However, barriers to addictive disorder screening exist and the feasibility of using these tests in primary care is unclear. This study aims to identify available addictive disorder screening tests whose feasibility has been evaluated in primary care. This systematic literature review was performed using Pubmed, PsycINFO, and the Cochrane Library databases. The search strategy included four research topics: addictive disorders, screening, primary care, and feasibility. Selection criteria included published studies evaluating the feasibility of an addictive disorder screening test in primary care. Data were extracted for each included article, and each analyzed screening test. Of the 4911 articles selected, 20 were included and 16 screening tests were studied. Physician feasibility was evaluated with satisfaction questionnaires or qualitative studies, mainly measuring test administration time. Patient feasibility was measured using criteria including "ease of use", comprehension, or format preference. Self-administered formats were preferred, especially electronic versions. Overall, the TAPS (Tobacco, Alcohol, Prescription medication, and other Substance use) tool provides a good balance between ease of use, brevity of administration and more extensive screening for substance use disorders. Feasibility appears to be a set of heterogeneous criteria relating to users, including comprehension or satisfaction, and practical aspects, including administration time or format preference. The criteria synthesized in this review could serve as a basis for screening test feasibility studies in primary care given the absence of feasibility study guidelines.
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Affiliation(s)
- Maxime Pautrat
- Department of General Practice, University of Tours, France
- University of Tours, EA7505 Education Ethique Santé, France
| | | | - Jean Pierre Lebeau
- Department of General Practice, University of Tours, France
- University of Tours, EA7505 Education Ethique Santé, France
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Pautrat M, Palluau R, Druilhe L, Lebeau JP. Exploring the general practitioners' point of view about clinical scores: a qualitative study. Diagn Progn Res 2023; 7:12. [PMID: 37309014 DOI: 10.1186/s41512-023-00149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/16/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Clinical scores help physicians to make clinical decisions, and some are recommended by health authorities for primary care use. As an increasing number of scores are becoming available, there is a need to understand general practitioner expectations for their use in primary care. The aim of this study was to explore general practitioner opinions about using scores in general practice. METHOD This qualitative study, with a grounded theory approach, used focus groups with general practitioners recruited from their own surgeries to obtain verbatim. Two investigators performed verbatim analysis to ensure data triangulation. The verbatim was double-blind labeled for inductive categorization to conceptualize score use in general practice. RESULTS Five focus groups were planned, 21 general practitioners from central France participated. Participants appreciated scores for their clinical efficacy but felt that they were difficult to use in primary care. Their opinions revolved around validity, acceptability, and feasibility. Participants have little regard for score validity, they felt many scores are difficult to accept and do not capture contextual and human elements. Participants also felt that scores are unfeasible for primary care use. There are too many, they are hard to find, and either too short or too long. They also felt that scores were complex to administer and took up time for both patient and physician. Many participants felt learned societies should choose appropriate scores. DISCUSSION This study conceptualizes general practitioner opinions about score use in primary care. The participants weighed up score effectiveness with efficiency. For some participants, scores helped make decisions faster, others expressed being disappointed with the lack of patient-centeredness and limited bio-psycho-social approach.
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Affiliation(s)
- Maxime Pautrat
- Faculty of Medicine, University of Tours, EA7505 Education Ethique Santé, 10 boulevard Tonnellé, 37000, Tours, France.
- Department of General Practice, Tours Regional University Hospital, Tours, France.
| | - Remy Palluau
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Loic Druilhe
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Jean Pierre Lebeau
- Faculty of Medicine, University of Tours, EA7505 Education Ethique Santé, 10 boulevard Tonnellé, 37000, Tours, France
- Department of General Practice, Tours Regional University Hospital, Tours, France
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Czihal M, Lottspeich C, Bernau C, Henke T, Prearo I, Mackert M, Priglinger S, Dechant C, Schulze-Koops H, Hoffmann U. A Diagnostic Algorithm Based on a Simple Clinical Prediction Rule for the Diagnosis of Cranial Giant Cell Arteritis. J Clin Med 2021; 10:jcm10061163. [PMID: 33802092 PMCID: PMC8001831 DOI: 10.3390/jcm10061163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Risk stratification based on pre-test probability may improve the diagnostic accuracy of temporal artery high-resolution compression sonography (hrTCS) in the diagnostic workup of cranial giant cell arteritis (cGCA). Methods: A logistic regression model with candidate items was derived from a cohort of patients with suspected cGCA (n = 87). The diagnostic accuracy of the model was tested in the derivation cohort and in an independent validation cohort (n = 114) by receiver operator characteristics (ROC) analysis. The clinical items were composed of a clinical prediction rule, integrated into a stepwise diagnostic algorithm together with C-reactive protein (CRP) values and hrTCS values. Results: The model consisted of four clinical variables (age > 70, headache, jaw claudication, and anterior ischemic optic neuropathy). The diagnostic accuracy of the model for discrimination of patients with and without a final clinical diagnosis of cGCA was excellent in both cohorts (area under the curve (AUC) 0.96 and AUC 0.92, respectively). The diagnostic algorithm improved the positive predictive value of hrCTS substantially. Within the algorithm, 32.8% of patients (derivation cohort) and 49.1% (validation cohort) would not have been tested by hrTCS. None of these patients had a final diagnosis of cGCA. Conclusion: A diagnostic algorithm based on a clinical prediction rule improves the diagnostic accuracy of hrTCS.
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Affiliation(s)
- Michael Czihal
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, 80336 Munich, Germany; (C.L.); (C.B.); (T.H.); (I.P.); (U.H.)
- Correspondence:
| | - Christian Lottspeich
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, 80336 Munich, Germany; (C.L.); (C.B.); (T.H.); (I.P.); (U.H.)
- Interdisciplinary Sonography Center, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, 80336 Munich, Germany
| | - Christoph Bernau
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, 80336 Munich, Germany; (C.L.); (C.B.); (T.H.); (I.P.); (U.H.)
| | - Teresa Henke
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, 80336 Munich, Germany; (C.L.); (C.B.); (T.H.); (I.P.); (U.H.)
| | - Ilaria Prearo
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, 80336 Munich, Germany; (C.L.); (C.B.); (T.H.); (I.P.); (U.H.)
| | - Marc Mackert
- Department of Ophthalmology, Hospital of the Ludwig-Maximilians-University, 80336 Munich, Germany; (M.M.); (S.P.)
| | - Siegfried Priglinger
- Department of Ophthalmology, Hospital of the Ludwig-Maximilians-University, 80336 Munich, Germany; (M.M.); (S.P.)
| | - Claudia Dechant
- Division of Rheumatology and Clinical Immunology, Medical Clinical and Policlinic IV, Hospital of the Ludwig-Maximilians-University, 80336 Munich, Germany; (C.D.); (H.S.-K.)
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Medical Clinical and Policlinic IV, Hospital of the Ludwig-Maximilians-University, 80336 Munich, Germany; (C.D.); (H.S.-K.)
| | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Hospital of the Ludwig-Maximilians-University, 80336 Munich, Germany; (C.L.); (C.B.); (T.H.); (I.P.); (U.H.)
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Cowley LE, Farewell DM, Maguire S, Kemp AM. Methodological standards for the development and evaluation of clinical prediction rules: a review of the literature. Diagn Progn Res 2019; 3:16. [PMID: 31463368 PMCID: PMC6704664 DOI: 10.1186/s41512-019-0060-y] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 05/12/2019] [Indexed: 12/20/2022] Open
Abstract
Clinical prediction rules (CPRs) that predict the absolute risk of a clinical condition or future outcome for individual patients are abundant in the medical literature; however, systematic reviews have demonstrated shortcomings in the methodological quality and reporting of prediction studies. To maximise the potential and clinical usefulness of CPRs, they must be rigorously developed and validated, and their impact on clinical practice and patient outcomes must be evaluated. This review aims to present a comprehensive overview of the stages involved in the development, validation and evaluation of CPRs, and to describe in detail the methodological standards required at each stage, illustrated with examples where appropriate. Important features of the study design, statistical analysis, modelling strategy, data collection, performance assessment, CPR presentation and reporting are discussed, in addition to other, often overlooked aspects such as the acceptability, cost-effectiveness and longer-term implementation of CPRs, and their comparison with clinical judgement. Although the development and evaluation of a robust, clinically useful CPR is anything but straightforward, adherence to the plethora of methodological standards, recommendations and frameworks at each stage will assist in the development of a rigorous CPR that has the potential to contribute usefully to clinical practice and decision-making and have a positive impact on patient care.
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Affiliation(s)
- Laura E. Cowley
- Division of Population Medicine, School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff University, Wales, CF14 4YS UK
| | - Daniel M. Farewell
- Division of Population Medicine, School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff University, Wales, CF14 4YS UK
| | - Sabine Maguire
- Division of Population Medicine, School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff University, Wales, CF14 4YS UK
| | - Alison M. Kemp
- Division of Population Medicine, School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff University, Wales, CF14 4YS UK
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Cardona M, Lewis ET, Kristensen MR, Skjøt-Arkil H, Ekmann AA, Nygaard HH, Jensen JJ, Jensen RO, Pedersen JL, Turner RM, Garden F, Alkhouri H, Asha S, Mackenzie J, Perkins M, Suri S, Holdgate A, Winoto L, Chang DCW, Gallego-Luxan B, McCarthy S, Petersen JA, Jensen BN, Backer Mogensen C, Hillman K, Brabrand M. Predictive validity of the CriSTAL tool for short-term mortality in older people presenting at Emergency Departments: a prospective study. Eur Geriatr Med 2018; 9:891-901. [PMID: 30574216 PMCID: PMC6267649 DOI: 10.1007/s41999-018-0123-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/24/2018] [Indexed: 12/11/2022]
Abstract
ABSTRACT To determine the validity of the Australian clinical prediction tool Criteria for Screening and Triaging to Appropriate aLternative care (CRISTAL) based on objective clinical criteria to accurately identify risk of death within 3 months of admission among older patients. METHODS Prospective study of ≥ 65 year-olds presenting at emergency departments in five Australian (Aus) and four Danish (DK) hospitals. Logistic regression analysis was used to model factors for death prediction; Sensitivity, specificity, area under the ROC curve and calibration with bootstrapping techniques were used to describe predictive accuracy. RESULTS 2493 patients, with median age 78-80 years (DK-Aus). The deceased had significantly higher mean CriSTAL with Australian mean of 8.1 (95% CI 7.7-8.6 vs. 5.8 95% CI 5.6-5.9) and Danish mean 7.1 (95% CI 6.6-7.5 vs. 5.5 95% CI 5.4-5.6). The model with Fried Frailty score was optimal for the Australian cohort but prediction with the Clinical Frailty Scale (CFS) was also good (AUROC 0.825 and 0.81, respectively). Values for the Danish cohort were AUROC 0.764 with Fried and 0.794 using CFS. The most significant independent predictors of short-term death in both cohorts were advanced malignancy, frailty, male gender and advanced age. CriSTAL's accuracy was only modest for in-hospital death prediction in either setting. CONCLUSIONS The modified CriSTAL tool (with CFS instead of Fried's frailty instrument) has good discriminant power to improve prognostic certainty of short-term mortality for ED physicians in both health systems. This shows promise in enhancing clinician's confidence in initiating earlier end-of-life discussions.
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Affiliation(s)
- Magnolia Cardona
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia.
| | - Ebony T Lewis
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, Australia
| | | | - Helene Skjøt-Arkil
- Department of Emergency Medicine, Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - Anette Addy Ekmann
- Department of Continuous Patient Progress, Bispebjerg og Frederiksberg Hospital, Copenhagen, Denmark
| | - Hanne H Nygaard
- Department of Emergency Medicine, Bispebjerg og Frederiksberg Hospital, Copenhagen, Denmark
| | | | | | | | - Robin M Turner
- Dean's Office Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Frances Garden
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Hatem Alkhouri
- Agency for Clinical Innovation, Emergency Care Institute, Chatswood, NSW, Australia
| | - Stephen Asha
- St George Hospital Emergency Department, Kogarah, NSW, Australia
| | - John Mackenzie
- Prince of Wales Hospital Emergency Department, Randwick, NSW, Australia
| | - Margaret Perkins
- Campbelltown Hospital Emergency Department, Campbelltown, NSW, Australia
| | - Sam Suri
- Campbelltown Hospital Intensive Care Unit, Campbelltown, NSW, Australia
| | - Anna Holdgate
- Liverpool Hospital Emergency Department, Liverpool, NSW, Australia
| | - Luis Winoto
- Sutherland Hospital Emergency Department, Sutherland, NSW, Australia
| | - David C W Chang
- Graduate School of Biomedical Engineering, The University of New South Wales, Kensington, NSW, Australia
| | - Blanca Gallego-Luxan
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Sally McCarthy
- Prince of Wales Hospital Emergency Department, Randwick, NSW, Australia
| | - John A Petersen
- Department of Emergency Medicine, Bispebjerg og Frederiksberg Hospital, Copenhagen, Denmark
| | - Birgitte N Jensen
- Department of Emergency Medicine, Bispebjerg og Frederiksberg Hospital, Copenhagen, Denmark
| | - Christian Backer Mogensen
- Department of Emergency Medicine, Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - Ken Hillman
- Liverpool Hospital Intensive Care Unit, Liverpool, NSW, Australia
- South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - Mikkel Brabrand
- Hospital of South West Jutland, Esbjerg, South Jutland, Denmark
- Odense University Hospital, Odense, Fyn, Denmark
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