title: How to improve opportunistic screening by using EMRs and other data. The prevalence of undetected diabetes mellitus in target population in Croatia.
abstract: OBJECTIVE
  Opportunistic screening for type 2 diabetes (T2D) has not been adopted as part of routine practice. The aim of the study was to investigate the yield of opportunistic target screening for T2D in Croatia and to evaluate the process of screening by using data from electronic medical record.
  
  
  METHODS
  We conducted opportunistic screening in 23 general practitioners (GPs) in a population of 13,344 patients aged 45-70 years.
  
  
  METHODS
  First, after excluding patients with T2D, patients with risk factors for T2D were derived from the electronic medical record and GP's assessment during the preconsultation phase. Second, those with data about normoglycemia in past three years were excluded. Remaining patients started the consultation phase during their usual visit, when they were offered capillary fasting plasma glucose testing in the next consultation.
  
  
  RESULTS
  Prevalence of T2D was 10.9% (new 1.4%). A total of 5568 (46.1%) patients had risks and 2849 (51.2%) had data about normoglycemia in the last three years. Using those data, number needed to invite to screening (NNI) was reduced to half: from 46.1% to 22.5%. One hundred eighty-four patients were screened positive for T2D in two capillary fasting plasma glucose tests (yield 9.8%). Number needed to screen (NNS) in order to detect one T2D was 10.3 patients. Among risks for T2D, overweight was the best predictive factor for undiagnosed T2D (odds ratio [OR]: 2.11, confidence interval [CI]:1.41-3.15, P < .001). Logistic regression showed that in targeted population, overweight patients with a family history in fold were 2.5 times more likely to have T2D (OR: 2.54, CI 1.78-.61, P < .001).
  
  
  CONCLUSIONS
  Total yield in targeted population was 1,4%. By using data about normoglycemia from EMRs, NNI was reduced by half and NNS was 10.3 patients. Our findings suggest the model for improvement in opportunistic screening.
authors.affiliation: Department of Family Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia. Electronic address: vrcabotica@yahoo.com.
authors.forename: M
authors.initials: M
authors.lastname: Vrca Botica
authors.affiliation: Department of Family Medicine, University of Prishtina, Prishtina, Kosovo. Electronic address: linda.carkaxhiu@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Carkaxhiu
authors.affiliation: Department of Informatics, University of Zagreb, School of Medicine, Zagreb, Croatia. Electronic address: jkern@snz.hr.
authors.forename: J
authors.initials: J
authors.lastname: Kern
authors.affiliation: Department of Endocrinology, University Hospital Zagreb, Croatia. Electronic address: ipavlic@mef.hr.
authors.forename: I
authors.initials: I
authors.lastname: Pavlić Renar
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Zagreb, Croatia. Electronic address: iva.botica@yahoo.com.
authors.forename: I
authors.initials: I
authors.lastname: Botica
authors.affiliation: Private Family Practice Bukovje, Croatia. Electronic address: ines.zelic@hi.t-com.hr.
authors.forename: I
authors.initials: I
authors.lastname: Zelić
authors.affiliation: Department of Family Medicine, University of Skopje, Macedonia. Electronic address: darkoiliev@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Iliev
authors.affiliation: Department of Neurology, Clinical Hospital Dubrava, Zagreb, Croatia. Electronic address: vrca1715@net.hr.
authors.forename: A
authors.initials: A
authors.lastname: Vrca
mesh_terms: D000328:Adult; D000368:Aged; D017523:Croatia / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D057286:Electronic Health Records; D005260:Female; D058005:General Practitioners; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D050177:Overweight; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors
keywords: Electronic medical records; Numbers of patients needed to invite and screen; Undetected type 2 diabetes