NAPCRG’s Annual Meeting is a forum for primary care researchers from across the globe to gather and present their research, collaborate for new research, and foster growth for up-and-coming researchers. The 2014 Annual Meeting will be held in New York, New York on November 21–25, 2014.
Two papers were selected and given the special designation of “distinguished paper” for excellence in research and contain the following factors: overall excellence, quality of research methods, quality of the writing, relevance to primary care clinical research, and overall impact of the research on primary care and/or clinical practice.
Below are brief summaries of this year’s papers:
Implementation Intentions and Colorectal Cancer Screening: A Randomized Trial in Safety-Net Clinics
K. Allen Greiner; Christine M. Daley; Aaron G Epp; Aimee James; Hung-Wen Yeh; Mugur Geana; Wendi K. Born; Kimberly Engelman; Jeremy Shellhorn; Christina M. Hester; Joseph W. LeMaster; Daniel BucklesD; Edward Ellerbeck
Context
Low-income and racial/ethnic minority populations experience disproportionate colorectal cancer (CRC) burden and poorer survival. Novel behavioral strategies are needed to improve screening rates in these groups.
Objectives
This trial was designed to test a theoretically based “implementation intentions” intervention for improving CRC screening among unscreened adults in urban safety-net clinics.
Design
Randomized controlled trial
Setting
Urban safety-net primary care practices
Patients
Adults (N = 470) aged ≥50 years, due for CRC screening
Intervention
The intervention was delivered via touchscreen computers that tailored informational messages to decisional stage and screening barriers. The computer then randomized participants to generic health information on diet and exercise (comparison group) or “implementation intentions” questions and planning (experimental group) specific to the CRC screening test chosen (FIT or colonoscopy).
Main and Secondary Outcome Measures
The primary study outcome was completion of CRC screening at 26 weeks based on test reports (analysis conducted 2012–2013).
Results
The study population had a mean age of 57 years, and was 42% non-Hispanic African American, 28% non-Hispanic white, and 27% Hispanic. Those receiving the implementation intentions-based intervention had a higher odds (adjusted odds ratio, AOR: 1.83; 95%CI, 1.23–2.73) of completing CRC screening than the comparison group. Those with higher self-efficacy for screening (AOR: 1.57; 95%CI, 1.03–2.39), history of asthma (AOR: 2.20; 95%CI, 1.26–3.84), no history of diabetes (AOR: 1.86; 95%CI, 1.21–2.86), and reporting they had never heard that “cutting on cancer” makes it spread (AOR: 1.78; 95%CI, 1.16–2.72) were more likely to complete CRC screening.
Conclusions
The results of this study suggest that programs incorporating an implementation intentions approach can contribute to successful completion of CRC screening even among very low income and diverse primary care populations. Future initiatives to reduce CRC incidence and mortality disparities may be able to employ implementation intentions in large-scale efforts to encourage screening and prevention behaviors.
Who Gets Diagnosed With Depression in Hong Kong’s Primary Care and What Happens to Them Over a Year?
Weng Yee Chin; Cindy Lam; Eric Wan
Context
Identifying and managing depression in primary care is challenging and factors affecting prognosis are not well understood, particularly in Asian settings.
Objective
To examine the naturalistic outcomes of primary care depression. Design Cross-sectional and 12-month cohort observational study using a practicebased primary care research network.
Setting
Public and private sector primary care clinics across Hong Kong
Participants
Adult patients were consecutively recruited from the waiting rooms of 59 primary care physicians to complete a questionnaire which included a depression screen. Blinded doctors recorded their diagnosis and management. Subjects (10,179) were recruited at baseline (response rate 81.0%); 4358 subjects (response rate 42.8%) agreed to follow-up by telephone at 3, 6, and 12 months. Instruments PHQ-9, SF-12v2, CESD-20, socio-demography and self-reported service use
Outcome Measures
Prevalence, incidence and remission rates for PHQ-9 screened-depression; health-related quality of life, and service utilization rates over 12 months.
Results
Prevalence of PHQ-9 screened-depression was 10.69%. Patients with a self-reported prior history of depression, higher PHQ-9 scores, lower SF-12v2 scores, and who were non-Chinese were most likely to be diagnosed with depression. Twelve-month remission rate was 60.31%. Detection status and baseline PHQ-9 severity were not predictive of remission, however doctor identification was associated with better improvements in mental health-related quality of life. Twelve-month incidence of PHQ-9 screened-depression was 5.25%. Screened-negative patients who received a diagnosis of depression at baseline were the most likely to become PHQ-9 positive over 1 year. Over 1 year, 19.7% of screened-positive subjects had consulted a psychiatrist, 8.9% other psychological services, and 37.5% had used psychotropic medications.
Conclusions
Around 1 in 10 primary care patients screen positive for depression. Most have mild, self-limiting symptoms, poor mental health-related quality of life, and increased use of primary and secondary care services. Doctor detection does not affect 12-month remission but enhances health-related quality of life.
- © 2014 Annals of Family Medicine, Inc.
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