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A Pilot Assessment of Primary Care Providers' Knowledge of Adrenal Insufficiency Diagnosis and Management.

ABSTRACT: Background and Objectives: Adrenal insufficiency (AI) is one of the most challenging diagnoses in primary care, and misdiagnosis is costly. The aim of this educational needs assessment was to assess primary care physicians' (PCPs) knowledge of AI diagnosis and management as a preliminary step in developing a professional education module to address knowledge of practice gaps. Methods: We developed a 12-item needs assessment and pretested questionnaire items prior to use to gather validity evidence. The questionnaire contained 4 AI knowledge items, 4 needs assessment items, and 4 demographic items. It was administered to 100 PCPs across a single integrated health care system over a 6-month period. Results: Fifty-one of 100 questionnaires were returned. The majority of respondents believed their knowledge of AI diagnosis and management was "average" when compared with peers. Responses indicated that PCPs were fairly comfortable diagnosing, but not managing AI patients. There was no association between respondents' clinical knowledge of AI and respondents' roles as clinical instructors (ie, having trainees assigned to them). A total of 54% of respondents said they utilized online resources to enhance current knowledge of AI and 88% of respondents said they would use a new AI resource, if available. When asked to rank preferences for professional development modalities, 26/38 respondents ranked UpToDate, 21/38 respondents ranked traditional lecture, and 19/38 respondents ranked case discussion among their top 3 choices. Conclusion: Results of this needs assessment showed that PCPs within our health care system both needed and desired professional development targeting AI diagnosis and management. A faculty development session, which included a short lecture and case scenarios, was developed and delivered to PCPs at participating family health centers. Session materials are now available for use by other institutions to meet professional development needs on this important topic.

SUBMITTER: Makin V

PROVIDER: S-EPMC6630069 | biostudies-other | 2019 Jan-Dec

REPOSITORIES: biostudies-other

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A Pilot Assessment of Primary Care Providers' Knowledge of Adrenal Insufficiency Diagnosis and Management.

Makin Vinni V Nowacki Amy S AS Colbert Colleen Y CY

Journal of primary care & community health 20190101

<b>Background and Objectives:</b> Adrenal insufficiency (AI) is one of the most challenging diagnoses in primary care, and misdiagnosis is costly. The aim of this educational needs assessment was to assess primary care physicians' (PCPs) knowledge of AI diagnosis and management as a preliminary step in developing a professional education module to address knowledge of practice gaps. <b>Methods:</b> We developed a 12-item needs assessment and pretested questionnaire items prior to use to gather v ...[more]

PMID: 31304843

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Project description:ObjectivesPrimary health care remains the widely available first point of medical care in Nigeria and in other low- and middle-income countries. Recognizing the rising prevalence of dementia in these settings, primary healthcare providers should be trained on cognitive assessment. However, little is known about the current Nigerian primary healthcare providers' knowledge of dementia, cognitive assessment tools, and use in elderly populations. The aim of this study was to evaluate primary healthcare providers' knowledge of dementia and cognitive assessment tools in Southeast Nigeria in preparation for the introduction of digital tablet-based assessment tool.MethodsThis is a cross-sectional mixed method descriptive pilot survey carried out in a comprehensive healthcare center affiliated with Nnamdi Azikiwe University Teaching Hospital. Fifty healthcare workers participated. Convenience sampling was employed involving all consenting primary healthcare providers in comprehensive healthcare center-Nnamdi Azikiwe University Teaching Hospital. A structured questionnaire was distributed for generation of both qualitative and quantitative data.ResultThe mean age of the 50 primary healthcare providers was 36.6 years, with females constituting 80%. Mean practice duration was 10.8 years. Their response on the mean age at which patients may need a cognitive assessment was reported as 52.8 years. Primary healthcare providers reported that dementia is associated with memory loss and can be genetically inherited. None of the respondents were familiar with Montreal cognitive assessment, or any form of tablet-based cognitive assessment tool. Most (86%) knew about the mini mental state examination.ConclusionPrimary healthcare providers are deficient in knowledge of dementia Alzheimer's or cognitive assessment tools, and so they do not routinely carryout cognitive screening in elderly patients during clinic visits. It is important to train all cadres of primary healthcare staff on the use and benefit of cognitive assessment using culturally validated user-friendly tool to improve quality of care for the elderly population.

Project description:BackgroundPrimary adrenal insufficiency (PAI) is life-threatening, and a definitive aetiological diagnosis is essential for management and prognostication. We conducted this study to investigate the genetic aetiologies of PAI in South China and explore their clinical features.MethodsSeventy children were enrolled in this cross-sectional study. Clinical information was collected, and combined genetic tests were performed according to the children's manifestations. Statistical analysis was performed among the different groups. In silico or in vitro experiments were applied to determine the pathogenicity of novel variants.ResultsAmong the 70 children, 84.3% (59/70) were diagnosed with congenital adrenal hyperplasia (CAH), and 21-hydroxylase deficiency (21-OHD) was genetically confirmed in 91.5% of these cases. Salt wasting (SW), simple virilization (SV), and non-classic (NC) CAH accounted for 66.1% (39/59), 30.5% (18/59), and 3.4% (2/59) of the cases, respectively. The 17-hydroxyprogesterone (17-OHP) and testosterone (TES) levels were significantly higher in children with SW than with SV. The 17-OHP and cortisol levels in female SW patients were significantly higher than those in males. The 17-OHP, cortisol, dehydroepiandrosterone (DHEAS) and TES levels in female SW patients were significantly higher than those in female SV patients. Additionally, 72.7% (8/11) of uncharacterized PAI patients had positive genetic findings. Among all the patients, two novel variants in the CYP21A2 gene (c.833dupT and c.651 + 2T > G) were found. A microdeletion (Xp21.2-21.3) and five novel variants, including 2 in the NR0B1 gene (c.323-324CG > GA and c.1231_1234delCTCA), 2 in the AAAS gene (c.399 + 1G > A and c.250delT) and 1 in the NNT gene (c.2274delT), were detected. The novel variant c.399 + 1G > A in the AAAS gene was further confirmed to lead to exon 4 skipping during mRNA transcription and produce a truncated ALADIN protein.ConclusionsWe found ethnicity-based differences in the CYP21A2 gene variant spectrum among different study populations. Female 21-OHD patients tended to have higher 17-OHP and TES levels, which warrants caution in relation to the effects of virilization. Novel gene variants detected in the CYP21A2, NR0B1, AAAS and NNT genes expanded the genetic spectrum of PAI, however, further improvement of genetic testing tools beyond our protocol are still needed to uncover the complete aetiology of PAI in children.

Dataset Information

A Pilot Assessment of Primary Care Providers' Knowledge of Adrenal Insufficiency Diagnosis and Management.

Publications

A Pilot Assessment of Primary Care Providers' Knowledge of Adrenal Insufficiency Diagnosis and Management.

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