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Opportunistic screenings in primary care

Page history last edited by Kirsten Holme 13 years, 7 months ago

Overall conclusion

Four studies on opportunistic screenings - three for diabetes and one for cardiovascular diseases - were identified. The studies lacked health economic evaluations. The study design is often badly described and has a poor validation of the screening methods. This is due to the fact that the evaluations have been performed in practice rather than in research settings.

However, opportunistic screenings were recommended in many mass screenings, as focus should be put on risk factors in screenings for lifestyle diseases such as type-2 diabetes, cardiovascular diseases and high cholesterol.

A documented effect of screenings for type-2 diabetes, cardiovascular diseases, high cholesterol, osteoporosis, general state of nutrition, and Helicobacter pylori has been found. The strongest study designs are found for type-2 diabetes and cardiovascular diseases, respectively.

In several studies concerning screening for type-2 diabetes and cardiovascular diseases, screenings targeted towards risk patients and lifestyle diseases are recommended. This originates in an economic argument and in the fact that there is a large overlapping in risk factors between the two disease groups.
The conclusion of this evidence report with respect to screening for type-2 diabetes is that screening in primary care settings allows screening patients presenting risk factors for type-2 diabetes. General population screenings are not cost-effective. Several screening methods could be combined in order to achieve results that are more precise because the validity of the joint screening hereby increases significantly.

The conclusion of general screenings for cardiovascular diseases is that screening in primary care settings combined with an effort for improving health status allows achieving a reduced risk for cardiovascular diseases by 13.7-53 %.

The conclusion of mass screenings for high cholesterol is that there are few studies dealing with this subject. The identified studies are not based on randomised designs and, therefore, give no background for concluding on the relevance of mass screenings for high cholesterol in primary care settings.
The conclusion as regards screening for osteoporosis is that evidence is missing for the advantages of these screenings and that the validity of the tests is not investigated. Therefore, the screenings are subject to large variation.

The conclusion for screening for other disorders is that additional screenings are possible in primary care settings; however, the evidence for effect is scanty.
Only few studies including the user’s perspective on screening programmes are identified.


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