Improving the detection of infectious diseases in at-risk migrants with an innovative integrated multi-infection screening digital decision support tool (IS-MiHealth) in primary care : a pilot cluster-randomized-controlled trial
Sequeira-Aymar, E. (Hospital Clínic i Provincial de Barcelona)
Cruz, Angeline (Hospital Clínic i Provincial de Barcelona)
Serra-Burriel, Miquel
di Lollo, Ximena (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Gonçalves, A. Q (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Camps-Vilà, Laura (Institut Català de la Salut)
Monclus-Gonzalez, Marta M (Institut Català de la Salut)
Revuelta-Muñoz, Elisa M (Institut Català de la Salut)
Busquet Solé, Nuria (Institut Català de la Salut)
Sarriegui-Domínguez, Susana (Institut Català de la Salut)
Casellas, Aina (Hospital Clínic i Provincial de Barcelona)
Dalmau Llorca, M. Rosa (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Aguilar Martín, Carina (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Jacques-Aviñó, Constanza (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Hargreaves, Sally (St. George's University of London)
Requena-Méndez, Ana (Hospital Clínic i Provincial de Barcelona)
Universitat Autònoma de Barcelona

Date:	2021
Abstract:	There are major shortfalls in the identification and screening of at-risk migrant groups. This study aims to evaluate the effectiveness of a new digital tool (IS-MiHealth) integrated into the electronic patient record system of primary care centres in detecting prevalent migrant infections. IS-MiHealth provides targeted recommendations to health professionals for screening multiple infections, including human immunodeficiency virus (HIV), hepatitis B and C, active tuberculosis (TB), Chagas disease, strongyloidiasis and schistosomiasis, based on patient characteristics (including variables of country of origin, age and sex). A pragmatic pilot cluster-randomized-controlled trial was deployed from March to December 2018. Eight primary care centres in Catalonia, Spain, were randomly allocated 1:1 to use of the digital tool for screening, or to routine care. The primary outcome was the monthly diagnostic yield of all aggregated infections. Intervention and control sites were compared before and after implementation with respect to their monthly diagnostic yield using regression models. This study is registered on international standard randomised controlled trial number (ISRCTN) (ISRCTN14795012). A total of 15 780 migrants registered across the eight centres had at least one visit during the intervention period (March-December 2018), of which 14 598 (92. 51%) fulfilled the criteria to be screened for at least one infection. There were 210 (2. 57%) individuals from the intervention group with new diagnoses compared with 113 (1. 49%) from the control group [odds ratio: 2. 08, 95% confidence interval (CI) 1. 63-2. 64, P < 0. 001]. The intervention centres raised their overall monthly diagnosis rate to 5. 80 (95% CI 1. 23-10. 38, P = 0. 013) extra diagnoses compared with the control centres. This monthly increase in diagnosis in intervention centres was also observed if we consider all cases together of HIV, hepatitis B and C, and active TB cases [2. 72 (95% CI 0. 43-5. 00); P = 0. 02] and was observed as well for the parasitic infections' group (Chagas disease, strongyloidiasis and schistosomiasis) 2. 58 (95% CI 1. 60-3. 57; P < 0. 001). The IS-MiHealth increased screening rate and diagnostic yield for key infections in migrants in a population-based primary care setting. Further testing and development of this new tool is warranted in larger trials and in other countries.
Grants:	Ministerio de Economía y Competitividad RD12/0018/0010
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	Journal of Travel Medicine, Vol. 29 (july 2021) , ISSN 1708-8305

DOI: 10.1093/jtm/taab100
PMID: 34230959

11 p, 473.9 KB

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