Liver function tests in patients with hypertension in primary care: a prospective cohort study.

BACKGROUND: Liver function tests (LFTs) are frequently used to monitor patients with hypertension in UK primary care. Evidence is lacking on whether testing improves outcomes. AIM: To estimate the diagnostic accuracy of LFTs in patients with hypertension and determine downstream consequences of testing. DESIGN & SETTING: Prospective study using the Clinical Practice Research Datalink (CPRD). METHOD: In total, 30 000 patients with hypertension who had LFTs in 2015 were randomly selected from CPRD. The diagnostic accuracy measures for eight LFT analytes and an overall LFT panel were calculated against the reference standard of liver disease. Rates of consultations, blood tests, and referrals within 6 months following testing were measured. RESULTS: The 1-year incidence of liver disease in patients with hypertension was 0.5% (95% confidence interval [CI] = 0.4% to 0.6%). Sensitivity and specificity of an LFT panel were modest: 61.3% (95% CI = 53.1% to 69.0%) and 73.8% (95% CI = 73.1% to 74.3%), respectively. The positive predictive value (PPV) of the eight individual LFT analytes were low ranging from 0.2% to 8.9%. Among patients who did not develop liver disease, mean number of consultations, referrals, and tests were higher in the 6 months following false-positives at 10.5, 0.7 and 29.8, respectively, compared with true-negatives: 8.6, 0.6, and 19.8. CONCLUSION: PPVs of LFTs in primary care were low, with high rates of false-positive results and increased rates of subsequent consultations, referrals, and blood testing. Avoiding LFTs for routine monitoring could potentially reduce patients' anxiety, GP workload, and healthcare costs.

The Impact of Covid-19 on Diabetes Care in Muscat Governorate: A Retrospective Cohort Study in Primary Care.

BACKGROUND: COVID-19 pandemic has led to health service modification and temporary disruption of the routine care provided to patients with diabetes mellitus (DM) in primary care. This was done to minimize outpatient visits, permit physical distancing, and ensure patients' and healthcare providers safety. There is no evidence that explored or measured the impact of COVID-19 pandemic on diabetes services and patients' glycemic outcome in Oman. AIM AND OBJECTIVES: To explore the accessibility of DM services in primary care after COVID-19 pandemic announcement, and measure patients' glycemic outcome. METHODS: Before and after, retrospective cohort study using Al-Shifa healthcare database in primary care. One thousand adult patients with diabetes who attended DM clinic before pandemic announcement in 2019 were randomly selected and followed up until end of 2020. Patients aged ≥18 years and had at least 2 visits in 2019 were included. Access to DM services was identified by number of patients received care, frequency of consultations, mode of consultation, and type of intervention given to patients. Patients' glycated hemoglobin (HbA1c), and other glycemic parameters after pandemic announcement in 2020 were determined and compared with the same parameters before pandemic in 2019. Association between patients' HbA1c and mode of consultation was measured using multivariable regression analysis. RESULTS: A total of 937 patients continued to follow and received DM care after pandemic announcement. Median number of consultations was 2 with interquartile range (IQR): 3-2. 57.4% had face-to-face alone, 32.4% had combined face to face and telephone consultation, and 10% had telephone consultation alone. Mean difference in HbA1c (%) before and after pandemic announcement was 0.2 ± 1.4 (95% CI: 0.1 to 0.3), P = .002. With multivariable linear regression, the mean difference in HbA1c was -0.3 (-2.3 to 1.5), P = .734 for telephone consultation alone, -0.5 (-2.4 to 1.4), P = .613 for face-to-face alone, and -0.5 (-2.4 to 1.3), P = .636 for combined consultations, compared to those who did not receive any formal consultation. CONCLUSION: Despite service modification and disruption of comprehensive care in primary care after COVID-19 pandemic announcement, DM services were accessible as majority of patients maintained follow up. There was an overall increase in mean glycated hemoglobin, however, it was a less than 1 unit increase. After adjusting for multivariable, glycated hemoglobin was reduced among those who received consultation including telephone consultation compared to those who did not, however evidence was unconvincing.

Awareness of Stomach and Colorectal Cancer Risk Factors, Symptoms and Time Taken to Seek Medical Help Among Public Attending Primary Care Setting in Muscat Governorate, Oman.

Colorectal and stomach cancers are the top ranking cancers in Oman. Most of the patients are diagnosed at advanced disease stages. The aim of this study is to explore the knowledge of risk factors, symptoms and the time needed to seek medical care for stomach cancer and colorectal cancer (CRC) among Omani participants attending 28 local health centres (LHCs) in the governorate of Muscat, the capital city of Oman. The Bowel Cancer/CRC Awareness Measure (CAM) questionnaire (translated into Arabic) was used to collect data from Omani adult participants (aged 18 years and above) who attended the LHCs during the study period. There was a total of 405 participants in the study out of the 500 who were invited (response rate = 81%). The most recognised risk factors were excessive drinking of alcohol (73.1%) and smoking (70.6%); the least recognised were doing less exercise (37.3%), eating food which was high in salt (26.8%) and a diagnosis of diabetes mellitus (24.9%). Multinomial logistic regression showed that young participants recognised more risk factors than older participants; highly educated participants recognised more risk factors than the less-educated and married participants recognised more risk factors than single participants. Participants with a high level of education were more likely to identify signs and symptoms of stomach cancer and CRC than less-educated participants. Multinomial logistic regression showed women were more likely than men to report barriers to seeking medical help (fear, difficulty in arranging transport, worried what the doctor might find). Also, participants with less education were more likely to report barriers than the highly educated (worried about wasting the doctor's time, difficulty in arranging transport, did not feel confident talking about symptoms, embarrassed, scared, worried what doctor might find). The majority of participants (93.6%) were not aware of any CRC screening programme or had undergone any screening (98.3) for CRC. Only 52.6% of participants would have a colonoscopy if the doctors advised; the main reasons for refusal were embarrassment (40.0%), lack of trust in the doctors (33.3%) and religious or culture beliefs (21.3%). Around 39% of participants would prefer to have their colonoscopy examination abroad. There is an urgent need to increase the public's awareness of stomach cancer and CRC in Oman, particularly with evidence emerging of an increase in the incidence. School curriculums could include sessions on cancer education and the information be reiterated to students periodically. A strategy to establish a CRC screening programme in Oman might be paramount as the incidence of CRC increased.