Journal of Primary Care and Community Health最新文献

{"title":"Promoting Social Participation in the Primary Care Field: An Ecological Study on the Potential Reduction of Multimorbidity Prevalence.","authors":"Ryota Takahashi, Tadao Okada, Kazushige Ide, Taishi Tsuji, Katsunori Kondo","doi":"10.1177/21501319241293717","DOIUrl":"10.1177/21501319241293717","url":null,"abstract":"<p><strong>Background: </strong>No municipal-level study has elucidated the social determinants associated with multimorbidity prevalence (MP).</p><p><strong>Objective: </strong>This article aimed to determine the differences in MP among municipalities and investigate factors associated with such differences through an ecological study of data obtained from a nationwide survey. This article focused on social participation and household income, which are associated with single chronic diseases, such as hypertension.</p><p><strong>Methods: </strong>Study design was a cross sectional study, which used the data from the Japan Gerontological Evaluation Study, a population-based gerontological study among functionally independent older adults aged ≥65 years in Japan. Overall, 152 212 participants from 2016 to 2017 across 91 municipalities were included in the final analysis. Multiple regression analysis was performed with MP as objective variable; social participation or household income were explanatory variables, and education, population density, and health check-ups were adjustment variables.</p><p><strong>Results: </strong>Intermunicipal differences in MP were 28.4% to 43.1% and 23.2% to 38.8% among men and women, respectively. Significant negative correlation was observed between MP and proportion of social participation (non-standardized coefficient [<i>B</i>] = -.18 for men and women). A significant positive correlation was noted between MP and equivalent household income of ≤2 million yen in women (<i>B</i> = .21).</p><p><strong>Conclusion: </strong>Considerable differences in MP existed among municipalities. Areas with high proportion of social participation showed significantly lower MP. Considering the difficulty in managing multimorbidity within the primary care field and limited evidence on effective interventions, community-level interventions encouraging social participation among older individuals might reduce MP. Primary care physicians should consider a community health approach for multimorbidity.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Biological and Social Factors on Mortality in Older Adults Living in Rural Communities.","authors":"Oscar H Del Brutto, Robertino M Mera, Denisse A Rumbea, Mark J Sedler","doi":"10.1177/21501319241228123","DOIUrl":"10.1177/21501319241228123","url":null,"abstract":"<p><strong>Background: </strong>Information on factors that increase mortality in remote settings is limited. This study aims to estimate the independent and joint role of several factors on mortality risk among older adults living in rural Ecuador.</p><p><strong>Methods: </strong>Participants were selected from community-dwelling older adults who were included in previous studies targeting mortality risk factors in the study population. Generalized structural equation modeling (GSEM) was utilized to evaluate prior causal assumptions, to redraw causal links, and to introduce latent variables that may help to explain how the independently significant variables are associated with mortality.</p><p><strong>Results: </strong>The study included 590 individuals (mean age: 67.9 ± 7.3 years; 57% women), followed for a median of 8.2 years. Mortality rate was 3.4 per 100 person-years. Prior work on separate multivariate Poisson and Cox models was used to build a tentative causal construct. A GSEM containing all variables showed that age, symptoms of depression, high social risk, high fasting glucose, a history of overt stroke, and neck circumference were directly associated with mortality. Two latent variables were introduced, 1 representing the impact of biological factors and another, the impact of social factors on mortality. The social variable significantly influenced the biological variable which carried most of the direct effect on mortality.</p><p><strong>Conclusions: </strong>Several factors contributed to mortality risk in the study population, the most significant being biological factors which are highly influenced by social factors. High social risk interact with biological variables and play an important role in mortality risk.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139541813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Mild Cognitive Impairment Using CogEvo: A Computerized Cognitive Function Assessment Tool.","authors":"Toru Satoh, Yoichi Sawada, Hideaki Saba, Hiroshi Kitamoto, Yoshiki Kato, Yoshiko Shiozuka, Tomoko Kuwada, Sayoko Shima, Kana Murakami, Megumi Sasaki, Yudai Abe, Kaori Harano","doi":"10.1177/21501319241239228","DOIUrl":"10.1177/21501319241239228","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>To assess the utility of the computerized cognitive function assessment tool, CogEvo, as a screening tool for mild cognitive impairment in primary care, we explored the relationship between CogEvo performance, age, and the severity of cognitive dysfunction evaluated by the Mini-Mental State Examination (MMSE).</p><p><strong>Methods: </strong>The observational cross-sectional study included 209 individuals' data (mean age 79.4 ± 8.9 years). We conducted a correlation analysis between CogEvo and MMSE scores, compared the performance among the 3 cognitive function groups (MMSE ≥ 28 group; MMSE24-27 group; MMSE ≤ 23 group) using the MMSE cut-off, and evaluated CogEvo's predictive accuracy for cognitive dysfunction through ROC analysis.</p><p><strong>Results: </strong>Both total CogEvo and MMSE scores significantly decreased with age. A significant positive correlation was observed between total CogEvo and MMSE scores, but a ceiling effect was detected in MMSE performance. Significant differences were observed in the total CogEvo score, including orientation and spatial cognitive function scores, among the 3 groups. CogEvo showed no educational bias. ROC analyses indicated moderate discrimination between the MMSE ≥ 28 group and the MMSE24-27 and MMSE ≤ 23 groups.</p><p><strong>Conclusions: </strong>The computer-administered CogEvo has the advantage of not exhibiting ceiling effects or educational bias like the MMSE, and was found to be able to detect age-related cognitive decline and impairment.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10953101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Risk Factors and Comorbidities With Chronic Pain in the Elderly Population.","authors":"Neil Mookerjee, Nicole Schmalbach, Gianna Antinori, Subhadra Thampi, Dylan Windle-Puente, Amy Gilligan, Ha Huy, Megha Andrews, Angela Sun, Roshni Gandhi, William Benedict, Austin Chang, Ben Sanders, Justin Nguyen, Maanika Reddy Keesara, Janet Aliev, Aneri Patel, Isaiah Hughes, Ian Millstein, Krystal Hunter, Satyajeet Roy","doi":"10.1177/21501319241233463","DOIUrl":"10.1177/21501319241233463","url":null,"abstract":"<p><strong>Introduction/objective: </strong>Chronic pain disorders affect about 20% of adults in the United States, and it disproportionately affects individuals living in the neighborhoods of extreme socioeconomic disadvantage. In many instances, chronic pain has been noted to arise from an aggregation of multiple risk factors and events. Therefore, it is of importance to recognize the modifiable risk factors. The aim of this study was to investigate the comorbid medical conditions and risk factors associated with chronic pain disorders in patients aged 65 years and older.</p><p><strong>Methods: </strong>Our team retrospectively reviewed medical records of elderly patients (65 years and older) who were evaluated in our outpatient medicine office between July 1, 2020 and June 30, 2021 for acute problems, management of chronic medical problems, or well visits. We divided our patients into a group who suffered from chronic pain disorder, and another group who did not have chronic pain disorder. The association of variables were compared between those groups.</p><p><strong>Results: </strong>Of the 2431 patients, 493 (20.3%) had a chronic pain disorder. A higher frequency of females in the group with chronic pain disorder was found compared to the group without a chronic pain disorder (60.6% vs 55.2%; <i>P</i> = .033). The mean ages between the two groups were similar in the group with a chronic pain disorder compared to the group without (76.35 ± 7.5 year vs 76.81 ± 7.59 year; <i>P</i> = .228). There were significant associations of certain comorbidities in the group with a chronic pain disorder compared to the group without a chronic pain disorder, such as depression (21.9% vs 15.2%; <i>P</i> < .001), anxiety (27.0% vs 17.1%; <i>P</i> < .001), chronic obstructive pulmonary disease (8.7% vs 6.1%; <i>P</i> = .036), obstructive sleep apnea (16.8% vs 11.6%; <i>P</i> = .002), gastroesophageal reflux disease (40.8% vs 29.0%; <i>P</i> < .001), osteoarthritis (49.3% vs 26.1%; <i>P</i> < .001), other rheumatologic diseases (24.9% vs 19.4%; <i>P</i> = .006), and peripheral neuropathy (14.4% vs 5.3%; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>Female sex, depression, anxiety, chronic obstructive pulmonary disease, obstructive sleep apnea, gastroesophageal reflux disease, osteoarthritis, other rheumatologic diseases, and peripheral neuropathy were significantly associated with chronic pain disorder in elderly patients, while BMI was not associated with chronic pain disorder.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139898294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a Legal Clinic Program Within an Urban Primary Health Care Center on Social Determinants of Health: A Program Evaluation.","authors":"Gina Agarwal, Melissa Pirrie, Dan Edwards, Bethany Delleman, Sharon Crowe, Hugh Tye, Jayne Mallin","doi":"10.1177/21501319241245849","DOIUrl":"https://doi.org/10.1177/21501319241245849","url":null,"abstract":"<p><strong>Background: </strong>Individuals living in poverty often visit primary healthcare clinics for health problems stemming from unmet legal needs. We examined the impact of a medical-legal partnership on improving the social determinants of health (SDoH), health-related quality of life, and perceived health status of attendees of a Legal Clinic Program (LCP).</p><p><strong>Methods: </strong>This was a pre-post program evaluation of a weekly LCP established within an urban primary healthcare clinic to provide free legal consultation. Patients aged 18 years or older were either approached or referred to complete a screening tool to identify potential legal needs. Those identified with potential legal needs were offered an appointment with LCP lawyers who provided legal counsel, referrals, and services. For those who attended the LCP, changes in SDoH and health indicators were collected via a self-reported survey 6 months after they attended the LCP and compared to their baseline scores using paired <i>t</i>-tests, McNemar's test for paired proportions, and the Wilcoxon Signed Rank Test for related samples.</p><p><strong>Results: </strong>During the 6-month evaluation period, 31 participants attended the LCP and completed both the baseline and 6-month surveys; 67.8% were female, 64.5% were white, 90.3% were not working full-time, and 61.3% had a household income of $700 to 1800 per month. At follow-up, 25.8% were receiving at least 1 new benefit and there was a statistically significant reduction in food insecurity (35.5% vs 9.7%, <i>P</i> < .05). Also, perceived health status using the visual analog scale (ranges from 0 to 100) significantly improved from 42.5 points (SD = 25.3) at baseline to 56.6 points (SD = 19.6) after 6 months (<i>P</i> < .05).</p><p><strong>Conclusions: </strong>The LCP has the potential to improve the health and wellbeing of patients in primary healthcare clinics by addressing unmet legal needs and SDoH.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11008340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effectiveness of an Information-Motivation Behavioral Skill Health Promotion Video on Health Status Among Chiang Mai University Personnel During the COVID-19 Pandemic.","authors":"Warawan Udomkhwamsuk, Patcharin Chaisurin, Wanicha Pungchompoo, Tanutporn Junsiri","doi":"10.1177/21501319241246396","DOIUrl":"https://doi.org/10.1177/21501319241246396","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this research was to study the effectiveness of the IMB Educational Health Promotion (IMBEHP) video for improving quality of life, health risk awareness, and health promotion among Chiang Mai University (CMU) personnel.</p><p><strong>Methods: </strong>This research was a quasi-experimental study with a 1-group pre-posttest design. The sample group included 528 CMU personnel who worked at the university between June 2020 and December 2021. Data collection was conducted before and after participants watched the IMB health promotion video.</p><p><strong>Results: </strong>After watching the video, the participants' quality of life scores were at a medium level. Moreover, physical health, mental health, social relations, and total quality of life score measures showed statistically significant differences between before and after viewing, at <i>P</i> < .05. The mean total for quality of life increased from the prior intervention implementation. Understanding of health risks also increased after watching the video, and the levels of health risk increased as follows: low level of health risk increased to 343 (64.96%), followed by medium and high health risk, at 21.78% (n = 115) and 10.04% (n = 53), respectively. Lastly, awareness about nutrition was statistically significant at .05.</p><p><strong>Conclusions: </strong>The results of this study demonstrate the efficacy of video in educating, motivating, and developing health-promoting skills among this population. After watching the video, CMU personnel increased their awareness of chronic disease risk factors, health promotion practice, illnesses prevention, healthy behaviors, and improvement of quality of life.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11036792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Cellulitis in the Unhoused: Case Study and Treatment Considerations.","authors":"Amelia Klamen, Richard Bryce, Symone Martin, Eli Benchell Eisman","doi":"10.1177/21501319241249437","DOIUrl":"10.1177/21501319241249437","url":null,"abstract":"<p><p>This report seeks to discuss sequelae of chronic cellulitis that is commonly treated in the ambulatory setting, as exacerbated by the conditions of living outside. Further we hope to identify etiologic factors that contribute to complication development. Additionally, this article will touch on unique treatment plan considerations for unhoused patients with the intention to educate providers and reduce mortality and morbidity relating to pedal skin and soft tissue infections in this population. This piece examines the case of a 52-year-old man with a history of chronic diseases, substance use disorder, and recurrent cellulitis. We highlight systemic issues in healthcare delivery for unhoused patients, including inadequate discharge planning, limited access to medication, and challenges in shelter placement. The discussion section emphasizes the importance of accurate diagnosis and tailored treatment plans for cellulitis in houseless individuals, the importance of a multidisciplinary approach incorporating social work services, and addressing chronic illnesses, substance use disorder, and housing issues. The report advocates for heightened awareness of bilateral cellulitis in unhoused populations, emphasizing the need for comprehensive, individualized treatment plans.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11282539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Workers in Canada Face Unequal Access to Healthcare: A Systems Thinking Approach.","authors":"Kaitlyn Squires","doi":"10.1177/21501319241233173","DOIUrl":"10.1177/21501319241233173","url":null,"abstract":"<p><strong>Objectives: </strong>Despite Canada's universal health system, sex workers across the country face an alarmingly high number of barriers when they seek to healthcare services. This has resulted in unmet healthcare needs and substantially poorer health outcomes than the general Canadian population. The objective of this study was to use a systems thinking approach to gain an in-depth understanding of the barriers sex workers face and how access could be improved.</p><p><strong>Methods: </strong>The analysis was conducted using a systems thinking methodology, which incorporates systems tools and inquiry processes. The methodology comprised 2 domains of inquiry: (1) Problem Landscape, (2) Solutions Landscape. Systems tools and methods, such as causal loop diagrams, iceberg diagram, and systems mapping, investigated the problem landscape for understanding the interconnected nature of the issue, alongside review of both published and gray literature. An environmental scan explored the current solutions landscape. These methods connected through systemic inquiry processes, including ongoing review and application of diverse perspectives, boundary judgments, interrelationships; enabled gaps and levers of change to be determined.</p><p><strong>Results: </strong>The main barriers sex workers face are stigma, criminalization, accessibility, and cost of healthcare. The stigma of sex work stems from otherization, paternalism, and moralistic, faith-based beliefs. The barriers unique to sex work are stigma and criminalization; both of which surface as avoidance, dislike, and/or fear of medical professionals. Five gaps each with a lever of change to improve access were identified: (1) Stigma - Collectivization and external collaboration, (2) Criminal status of sex work - Decriminalization, (3) Lack of adequate education - Improved healthcare professional training and anti-discriminatory health policies, (4) Lack of support - Increased community-based healthcare services, (5) Cost of healthcare - Universal coverage of \"secondary\" healthcare components.</p><p><strong>Conclusion: </strong>Through reducing the stigma surrounding sex work, making changes that improve the healthcare services that sex workers receive, and collaboration between involved parties, sex workers can be prevented from falling through the cracks of the Canadian healthcare system; lessening the health inequities sex workers face and improving their health outcomes.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10953055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Homeless Temporarily-Housed in Project RoomKey During the COVID-19 Pandemic.","authors":"Kylie Sloan, Alexis Coulourides Kogan, Jodie Guller, Corinne T Feldman, Brett J Feldman","doi":"10.1177/21501319241234869","DOIUrl":"10.1177/21501319241234869","url":null,"abstract":"<p><strong>Introduction: </strong>People experiencing unsheltered homelessness (PEUH) have higher disease burden yet limited access to healthcare. COVID-19 introduced even greater risk for PEUH aged 65+ years with an underlying chronic health condition and were temporarily housed in hotels/motels for Project RoomKey (PRK). This study aimed to characterize a PRK cohort who received primary care from a street medicine program.</p><p><strong>Methods: </strong>This observational case series study included a sample of 35 PRK participants receiving primary care from a street medicine team at a single site from July to September 2020. We used the HOUSED BEDS assessment tool for taking history on PEUH.</p><p><strong>Results: </strong>Participants were 63% male, 40% Hispanic/Latino/a, 40% white, 94% English-speaking, and 73% had chronic health conditions. Assessment revealed: average Homelessness (H) of 4 years; 76% had no prior social service Outreach (O); average Utilization (U) was 4 emergency department visits in prior 6-months; 68% received Salary (S) from government income; Food access or Eat (E) was commonly purchased (29%) or donated (26%); clean water to Drink (D) for 59% of participants; 86% had access to a Bathroom (B); Encampment (E) was varied and 38% reported safety concerns; Daily routine (D) showed 76% could access a telephone, 32% received social support from family; 79% reported past or current Substance use (S). No participants contracted COVID-19 during study period.</p><p><strong>Conclusions: </strong>This study describes health and demographic characteristics of PRK participants in Southern California. Findings inform policies to continue PRK that includes onsite healthcare such as via street medicine.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10943723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140140916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recalibration of a Non-Laboratory-Based Risk Model to Estimate Pre-Diabetes/Diabetes Mellitus Risk in Primary Care in Hong Kong.","authors":"Will H G Cheng, Weinan Dong, Emily T Y Tse, Linda Chan, Carlos K H Wong, Weng Y Chin, Laura E Bedford, Wai Kit Ko, David V K Chao, Kathryn C B Tan, Cindy L K Lam","doi":"10.1177/21501319241241188","DOIUrl":"10.1177/21501319241241188","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>A non-laboratory-based pre-diabetes/diabetes mellitus (pre-DM/DM) risk prediction model developed from the Hong Kong Chinese population showed good external discrimination in a primary care (PC) population, but the estimated risk level was significantly lower than the observed incidence, indicating poor calibration. This study explored whether recalibrating/updating methods could improve the model's accuracy in estimating individuals' risks in PC.</p><p><strong>Methods: </strong>We performed a secondary analysis on the model's predictors and blood test results of 919 Chinese adults with no prior DM diagnosis recruited from PC clinics from April 2021 to January 2022 in HK. The dataset was randomly split in half into a training set and a test set. The model was recalibrated/updated based on a seven-step methodology, including model recalibrating, revising and extending methods. The primary outcome was the calibration of the recalibrated/updated models, indicated by calibration plots. The models' discrimination, indicated by the area under the receiver operating characteristic curves (AUC-ROC), was also evaluated.</p><p><strong>Results: </strong>Recalibrating the model's regression constant, with no change to the predictors' coefficients, improved the model's accuracy (calibration plot intercept: -0.01, slope: 0.69). More extensive methods could not improve any further. All recalibrated/updated models had similar AUC-ROCs to the original model.</p><p><strong>Conclusion: </strong>The simple recalibration method can adapt the HK Chinese pre-DM/DM model to PC populations with different pre-test probabilities. The recalibrated model can be used as a first-step screening tool and as a measure to monitor changes in pre-DM/DM risks over time or after interventions.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10996357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}