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

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.

[ACCUSTOMING TO HELICOBACTER PYLORI BACTERIUM IN FAMILY PRACTICE].

Today, antibiotic resistance of Helicobacter pylori (HP) is a worldwide problem. The 'test and treat' strategy is the recommended approach in family medicine, as family medicine doctors make decisions on treating gastrointestinal conditions without endoscopic findings or HP testing. In treatment strategy, family medicine doctor has to answer several questions: whether the patient has HP infection, is it necessary to evaluate HP infection, which diagnostic test to use in evaluation of HP infection, should he proscribe antibiotic, and which antibiotic to prescribe. In this article, we present three common clinical cases to determine which approach to use in daily practice: dyspepsia, gastroesophageal reflux disease (GERD), and extragastric diseases associated with HP infection. Serology test, stool antigen test and urea breath test are described. It is required from family medicine doctors not only to rationalize antibiotic prescription but also to eradicate HP infection at the same time. We need to have in mind that disease is a result of the host-agent (bacterium) interaction that varies in time and possible damage/impairment from the disease.