Article Figures & Data
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- Figure 1.
Paradigm shift in preventive screening practice organization
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GUIDELINE RELEVANT POSITIVE RECOMMENDATION (STRENGTH OF RECOMMENDATION) Cervical cancer5 For women aged 30 to 69 we recommend routine screening for cervical cancer every 3 years (strong) Hypertension6 We recommend blood pressure measurement at all appropriate primary care visits (strong) Diabetes7 For 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 cancer8 For women aged 50 to 69 years we recommend routinely screening with mammography every 2 to 3 years (weak) Colorectal cancer9 We 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 cancer10 For 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)Obesity11 These 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.
ATTRIBUTE DEFINITION PRIMARY CARE PREVENTIVE SCREENING EXAMPLES Agents who learn People can and will process information, as well as react to changes in information Team members access knowledge translation tools to understand a conditional recommendation and then apply the knowledge in discussions with patients Interconnectedness Individuals and groups connect and interact in multiple ways, formally and informally and changing over time Different 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-organization Order is created in a system without explicit hierarchical direction Nurse 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-evolution The system and the environment influence each other’s development Over 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
