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OtherPractice

Practice organization for preventive screening

Brenda J. Wilson, Neil R. Bell, Roland Grad, Guylène Thériault, James A. Dickinson, Harminder Singh, Stéphane Groulx and Olga Szafran
Canadian Family Physician November 2018; 64 (11) 816-820;
Brenda J. Wilson
Associate Dean and Professor in the Division of Community Health and Humanities at Memorial University of Newfoundland in St John’s.
MB ChB MSc MRCP(UK) FFPH
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  • For correspondence: bwilson@mun.ca
Neil R. Bell
Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
MD SM CCFP FCFP
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Roland Grad
Associate Professor in the Department of Family Medicine at McGill University and Senior Investigator at the Lady Davis Institute in Montreal, Que.
MD CM MSc CCFP FCFP
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Guylène Thériault
Associate Vice Dean of Distributed Medical Education and Academic Lead for the Physicianship Component at Outaouais Medical Campus at McGill University.
MD CCFP
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James A. Dickinson
Professor in the Department of Family Medicine and the Department of Community Health Sciences at the University of Calgary in Alberta.
MB BS PhD CCFP FRACGP
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Harminder Singh
Associate Professor in the Department of Internal Medicine and the Department of Community Health Sciences at the University of Manitoba in Winnipeg and in the Department of Hematology and Oncology for CancerCare Manitoba.
MD MPH FRCPC
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Stéphane Groulx
Assistant Clinical Professor in the Department of Community Health Sciences at the University of Sherbrooke and Associate Researcher at the Charles-LeMoyne Hospital Research Centre in Sherbrooke, Que.
MD CCFP FCFP
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Olga Szafran
Associate Director of Research in the Department of Family Medicine at the University of Alberta in Edmonton.
MHSA
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    Figure 1.

    Paradigm shift in preventive screening practice organization

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    Table 1.

    Canadian Task Force for Preventive Health Care recommendations relevant to Nadia

    GUIDELINERELEVANT POSITIVE RECOMMENDATION (STRENGTH OF RECOMMENDATION)
    Cervical cancer5For women aged 30 to 69 we recommend routine screening for cervical cancer every 3 years (strong)
    Hypertension6We recommend blood pressure measurement at all appropriate primary care visits (strong)
    Diabetes7For adults at low to moderate risk of diabetes (determined with a validated risk calculator), we recommend not routinely screening for type 2 diabetes (weak) For adults at high risk of diabetes (determined with a validated risk calculator), we recommend routinely screening every 3 to 5 years with hemoglobin A1c level (weak) For adults at very high risk of diabetes (determined with a validated risk calculator), we recommend routine screening annually with hemoglobin A1c level (weak)
    Breast cancer8For women aged 50 to 69 years we recommend routinely screening with mammography every 2 to 3 years (weak)
    Colorectal cancer9We recommend screening adults aged 60 to 74 years for colorectal cancer with FOBT (either guaiac FOBT or FIT) every 2 years or flexible sigmoidoscopy every 10 years (strong)
    Lung cancer10For adults aged 55 to 74 years with at least a 30 pack-year* smoking history who currently smoke or quit < 15 years ago, we recommend annual screening with LDCT up to 3 consecutive times. Screening should only be carried out in health care settings with expertise in early diagnosis and treatment of lung cancer (weak)
    For all other adults, regardless of age, smoking history, or other risk factors, we recommend not screening for lung cancer with LDCT (strong)
    Obesity11These recommendations apply to apparently healthy adults ≥ 18 years of age who present to primary care
    We recommend measuring height and weight and calculating body mass index at appropriate primary care visits (strong)
    • FIT—fecal immunochemical testing, FOBT—fecal occult blood testing, LDCT—low-dose computed tomography.

    • ↵* Pack-year is defined as the average number of cigarette packs smoked daily multiplied by the number of years smoking.

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    Table 2.

    Attributes of complex adaptive systems

    ATTRIBUTEDEFINITIONPRIMARY CARE PREVENTIVE SCREENING EXAMPLES
    Agents who learnPeople can and will process information, as well as react to changes in informationTeam members access knowledge translation tools to understand a conditional recommendation and then apply the knowledge in discussions with patients
    InterconnectednessIndividuals and groups connect and interact in multiple ways, formally and informally and changing over timeDifferent practice staff groups (physicians, nurses, nurse practitioners, administrative staff) are involved in developing pathways toward shared decision making that respect patients’ preferences about cancer screening
    Self-organizationOrder is created in a system without explicit hierarchical directionNurse practitioners develop their own approach to organizing patient flow for diabetes risk assessment, which is then included in the practice’s overall preventive screening plan
    Co-evolutionThe system and the environment influence each other’s developmentOver the course of a year, recognizing that the practice waiting times for doctor appointments are rising, the team pilot-tests additional monthly nurse-led group information sessions about cancer screening tests
    • Adapted from Leykum et al.22

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Canadian Family Physician: 64 (11)
Canadian Family Physician
Vol. 64, Issue 11
1 Nov 2018
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Practice organization for preventive screening
Brenda J. Wilson, Neil R. Bell, Roland Grad, Guylène Thériault, James A. Dickinson, Harminder Singh, Stéphane Groulx, Olga Szafran
Canadian Family Physician Nov 2018, 64 (11) 816-820;

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Practice organization for preventive screening
Brenda J. Wilson, Neil R. Bell, Roland Grad, Guylène Thériault, James A. Dickinson, Harminder Singh, Stéphane Groulx, Olga Szafran
Canadian Family Physician Nov 2018, 64 (11) 816-820;
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  • Article
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    • Preventive screening practice within a broader context
    • What does this mean for organizing preventive screening in a primary care context?
    • Importance of a team approach
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