Reference no: EM132271144

Research Prospectus:

Title -Compliance with the United States Preventive Services Task Force (USPSTF) AAA Screening (Abdominal Aortic aneurysms)

Purpose/hypothesis

Abdominal Aortic Aneurysms have been shown to account for the major mortality and morbidity rates in adults. The reason for this is because, for AAA, most of the symptoms lie dormant and rarely show until the disease gets to an advanced stage and there is a rupture of the Aorta.

As such, regular screening is important since it allows for early detection of the disease allowing doctors to be able to manage the condition before rupture occurs. Men aged between 65-75 years which are past or present smokers are at a greater risk of developing an AAA. For this reason, this group of patients that would benefit greatly from early detection in the form of screening and reparative surgical treatment.

he purpose of the proposed study was to determine the percentage of ever-smoking males 65-75 years of age who have undergone CT screening for Abdominal Aortic aneurysms (AAAs), as recommended by the United States Preventive Services Task Force (USPSTF), and the percentage of PCPs who recommend such screening as part of annual/interval physical examinations.

The research thus hypothesizes that a low percentage of eligible males undergo such screening and a low percentage of physicians recommend such screening despite the high prevalence of AAA among members of these group.

Background

AAA is defined as a dilation that occurs on the abdominal aorta causing the aorta to expand to 50% of its normal size to diameters of 3 centimeters or more. Consequently, the epidemiology of AAA is acquired from scanning and screening at-risk populations and autopsy studies.

As such, based on the studies conducted so far, epidemiology rates range from 4% to 8% in men, and about 1% of AAA cases have been reported in women. In addition, data collected by the Veterans Affairs Co-operative Study showed that 3.6% of the males screened had an aneurysm of 3cm while another 1.2% of the candidates had an aneurysm of 4cm or more (Zucker, & Prabhakar, 2018). Their study shows that the incidence of AAA ranges from 40.6-49.3 for every 100,000 men and 6.8-12 for every 100, 000 women in the US. (Zucker, & Prabhakar, 2018).

To combat the above-increased rates of AAA rates among Americans, the Department of Health developed the USPSTF guidelines in 2005 which recommended AAA screening for males between the age of 65 and 75 who had smoked 100 cigarettes or more in their lifetime (Aggarwal, Qamar, Sharma & Sharma, 2011).

The guidelines aim to ensure that most men who fit the above characteristics were screened in order to adopt preventive measures to combat the issue. However, for individuals who did not smoke, the agency did not make any recommendations and also advised against screening for women since their comorbidity rates were shown to be low. The rationale behind the guidelines was that screening would help to mitigate the disease by identifying if individuals had AAA or not.

In 2014, the USPSTFF updated the guidelines requiring one-time sonography for all elderly male smokers. However, for nonsmokers, the agency reported that screening could be selectively offered to these individuals depending on patient preference or professional opinion. With respect to these guidelines, the organization expected that screening rates will increase. However, a study conducted by (Aggarwal, Qamar, Sharma & Sharma, 2011), shows that screening only increased in the male ever smoker categories while no appreciable change has been seen in other demographic groups.

Consequently, in respect to the hypothesis which shows that there have been low screening rates, the USPSTFF has constantly updated their recommendations to encourage screening as shown by the updated guidelines as shown in the 2014 by-laws (Dahl, Hasselgård & Myhre, 1999).

In addition, the organization is also providing new guidelines this year to demonstrate that screening should be carried out among at-risk populations. As such, it is important for clinical imagers to be aware of future guidelines and revisions and also to be aware of associated practices required of them and the implications of their actions.

Materials & Methods

Data will be collected from chart review of eligible patients (ever-smoker males 65-75 years of age undergoing annual/interval physical examinations without previous screening or diagnosis of an AAA). This is a preliminary study with a target sample size of 100 (10 charts/PCP).

PCPs (FPs and internists) with private offices in Washington DC, Maryland, and Virginia, will be interviewed face-to-face to determine whether or not they recommend CT screening of ever-smoker males 65-75 years of age during annual/interval physical examinations. The target sample size is 10.

Consequently, the data collection will be aimed at determining how many times PCP's have recommended screening for people in this age bracket and how many times PCP's have screened a patient. As such, the questions that will be directed at people in this subgroup will entail;

1. Are you aware of the current standards that instruct AAA screening?

2. How many patients who are smoker males between 65-75 years of age have you screened for the presence of an AAA?

3. Have you recommended AAA screening for a patient as a precautionary measure and if so when did the doctor recommend that?

4. Do you think AAA screening for people this age is important and if so why?

To maintain data validity and ensure that the data collected will be within the stipulated guidelines of research, a waiver will be requested from the Ethics Committee for the retrospective chart review. Informed consent will be obtained from the interviewed physicians and anonymity will be guaranteed. IRB approval will be requested.

Statistical analysis

The triangulation model will be used for data sampling while qualitative data analysis models will be utilized to evaluate the results of the respondents.

In addition, quantitative models of data analysis will also be utilized in order to determine if the results collected adhere to the hypothesis. The results will thus be analyzed to determine whether they affirm the hypothesis or have disproved it.

Budget

There will be no costs associated with the study.

Discussion

This study will provide data for clinicians with respect to the prevalence of AAA and whether screening guidelines are followed. This may encourage clinicians to be better aware of the importance of early detection by screening, and thus may result in increased screening rates in active male smokers aged between 65-75 years of age in order to reduce comorbidity and mortality rates.

As such, my study will likely transform clinical practices leading to the adoption of minimally invasive technologies and imaging devices in order to facilitate increased screening and better patient outcomes in the coming years.

In addition, the study will likely prompt clinicians to adopt mandatory screening for patients who are smokers and even recommend patients who are non-smokers to get screened for AAA based on their medical and physiologic histories. As such, the study will lead to improvement and optimization in screening practices, better management of incidental findings and regular follow-ups.