Dataset Information

A comparison of screening methods for sleep disorders in Australian community pharmacies: a randomized controlled trial.

ABSTRACT:

Background

Community pharmacies may potentially assist in screening for chronic conditions such as sleep disorders, which remain both under-diagnosed and untreated. We aimed to compare a subjective risk-assessment-only questionnaire (RAO) for common sleep disorder screening against the same risk-assessment questionnaire plus a nasal flow monitor as an objective marker of possible underlying obstructive sleep apnea (OSA) (RA+) in a community pharmacy setting. The primary outcome was the number of participants identified in RAO or RA+ group who were likely to have and consequently be diagnosed with OSA. Further outcomes included the number of participants identified as being at risk for, referred for, taking-up referral for, and then diagnosed with OSA, insomnia, and/or restless legs syndrome (RLS) in either group.

Methods

In a cluster-randomized trial, participants were recruited through 23 community pharmacies. Using validated instruments, 325 (RAO?=?152, RA+?=?173) participants were screened for OSA, insomnia, and RLS.

Findings

218 (67%) participants were at risk of OSA, insomnia or RLS and these participants were referred to their primary physician. The proportion of screened participants identified as being at risk of OSA was significantly higher in the RA+ group (36% in RAO vs. 66% in RA+, OR 3.4, 95% CI (1.8-6.5), p<0.001). A 12-month follow-up was completed in 125 RAO and 155 RA+ participants. Actual referral uptake was 34% RAO, 26% RA+, OR 4.4, 95% CI (1.4-19.2), p?=?0.31. The OSA diagnosis rate was higher in the RA+ arm (p?=?0.01). To yield a single additional confirmed OSA diagnosis, 16 people would need to be screened using the RA+ protocol.

Conclusions

These results demonstrate that utilising either screening method is feasible in identifying individuals in the community pharmacy setting who are likely to have OSA, insomnia and/or RLS. Secondly, adding an objective marker of OSA to a questionnaire-based prediction tool resulted in more confirmed OSA diagnoses.

Trial registration

ACTR.org.au ACTRN12608000628347.

SUBMITTER: Fuller JM

PROVIDER: S-EPMC4076224 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Publications

A comparison of screening methods for sleep disorders in Australian community pharmacies: a randomized controlled trial.

Fuller Joanne M JM Wong Keith K KK Grunstein Ronald R Krass Ines I Patel Jayshree J Saini Bandana B

PloS one 20140630 6

<h4>Background</h4>Community pharmacies may potentially assist in screening for chronic conditions such as sleep disorders, which remain both under-diagnosed and untreated. We aimed to compare a subjective risk-assessment-only questionnaire (RAO) for common sleep disorder screening against the same risk-assessment questionnaire plus a nasal flow monitor as an objective marker of possible underlying obstructive sleep apnea (OSA) (RA+) in a community pharmacy setting. The primary outcome was the n ...[more]

PMID: 24978952

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Project description:INTRODUCTION:With the rising prevalence of type 2 diabetes in Australia, screening and earlier diagnosis is needed to provide opportunities to intervene with evidence-based lifestyle and treatment options to reduce the individual, social and economic impact of the disease. The objectives of the Pharmacy Diabetes Screening Trial are to compare the clinical effectiveness and cost-effectiveness of three screening models for type 2 diabetes in a previously undiagnosed population. METHODS AND ANALYSIS:The Pharmacy Diabetes Screening Trial is a pragmatic cluster randomised controlled trial to be conducted in 363 community pharmacies across metropolitan, regional and remote areas of Australia, randomly allocated by geographical clusters to one of three groups, each with 121 pharmacies and 10 304 screening participants. The three groups are: group A: risk assessment using a validated tool (AUSDRISK); group B: AUSDRISK assessment followed by point-of-care glycated haemoglobin testing; and group C: AUSDRISK assessment followed by point-of-care blood glucose testing. The primary clinical outcome measure is the proportion of newly diagnosed cases of type 2 diabetes. Primary outcome comparisons will be conducted using the Cochran-Mantel-Haenszel test to account for clustering. The secondary clinical outcomes measures are the proportion of those who (1) are referred to the general practitioner (GP), (2) take up referral to the GP, (3) are diagnosed with pre-diabetes, that is, impaired glucose tolerance or impaired fasting glucose and (4) are newly diagnosed with either diabetes or pre-diabetes. The economic outcome measure is the average cost (direct and indirect) per confirmed new case of diagnosed type 2 diabetes based on the incremental net trial-based costs of service delivery and the associated incremental longer term health benefits from a health funder perspective. ETHICS AND DISSEMINATION:The protocol has been approved by the Human Research Ethics Committees at University of Sydney and Deakin University. Results will be available on the Sixth Community Pharmacy Agreement website and will be published in peer reviewed journals. TRIAL REGISTRATION NUMBER:ACTRN12616001240437; Pre-results.

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Dataset Information

A comparison of screening methods for sleep disorders in Australian community pharmacies: a randomized controlled trial.

Background

Methods

Findings

Conclusions

Trial registration

Publications

A comparison of screening methods for sleep disorders in Australian community pharmacies: a randomized controlled trial.

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