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Sequeira-Aymar E, Cruz A, Serra-Burriel M, et al. 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. J Travel Med. 2021;doi: 10.1093/jtm/taab100.
Sequeira-Aymar, E., Cruz, A., Serra-Burriel, M., di Lollo, X., Gonçalves, A. Q., Camps-Vilà, L., Monclus-Gonzalez, M. M., Revuelta-Muñoz, E. M., Busquet-Solé, N., Sarriegui-Domínguez, S., Casellas, A., Llorca, M. R. D., Aguilar-Martín, C., Jacques-Aviñó, C., Hargreaves, S., & Requena-Méndez, A. (2021). 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. Journal of travel medicine, . https://doi.org/10.1093/jtm/taab100
Sequeira-Aymar, Ethel, et al. "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." Journal of travel medicine vol. (2021). doi: https://doi.org/10.1093/jtm/taab100
Sequeira-Aymar E, Cruz A, Serra-Burriel M, di Lollo X, Gonçalves AQ, Camps-Vilà L, Monclus-Gonzalez MM, Revuelta-Muñoz EM, Busquet-Solé N, Sarriegui-Domínguez S, Casellas A, Llorca MRD, Aguilar-Martín C, Jacques-Aviñó C, Hargreaves S, Requena-Méndez A. 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. J Travel Med. 2021 Jul 06; doi: 10.1093/jtm/taab100. Epub 2021 Jul 06. PMID: 34230959.
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J Travel Med. 2021 Jul 06; doi: 10.1093/jtm/taab100. Epub 2021 Jul 06.

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.

Journal of travel medicine

Ethel Sequeira-Aymar, Angeline Cruz, Miquel Serra-Burriel, Ximena di Lollo, Alessandra Queiroga Gonçalves, Laura Camps-Vilà, Marta M Monclus-Gonzalez, Elisa M Revuelta-Muñoz, Nuria Busquet-Solé, Susana Sarriegui-Domínguez, Aina Casellas, Maria Rosa Dalmau Llorca, Carina Aguilar-Martín, Constanza Jacques-Aviñó, Sally Hargreaves, Ana Requena-Méndez

Affiliations

  1. Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Casanova, Carrer Rosselló 161, 08036 Barcelona, Spain.
  2. August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Carrer Rosselló, 149, Barcelona, Spain.
  3. Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Rosello 132, 40, 08036 Barcelona, Spain.
  4. Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Rämistrasse 71, 8006 Zürich, Switzerland.
  5. Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain.
  6. Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L'Ebre, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain.
  7. Centre d'Atencio Primaria Plaça Catalunya, Institut Català de la Salut (ICS), Carrer Soler i March, 6, 08242 Manresa, Spain.
  8. Centre d'Atencio Primaria Sagrada Família, Consorci Sanitari Integral (CSI), Carrer Còrsega 643, 08025 Barcelona, Spain.
  9. Centre d'Atencio Primaria Rambla Ferran, Institut Català de la Salut (ICS), Carrer Rambla Ferran 44, 25007, Lleida, Spain.
  10. Centre d'Atencio Primaria Sagrada Família, Institut Català de la Salut, Carrer St. Cristòfol, 34, 08243 Manresa, Barcelona, Spain.
  11. Centre d'Atencio Primaria 1 Maig, Institut Català de la Salut (ICS), Carrer De la Mercè, 5, 25003, Lleida, Spain.
  12. Equip d'Atenció Primària Tortosa Est, Institut Català de la Salut, Avenida Generalitat 95, 43500, Tortosa, Tarragona, Spain.
  13. Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain.
  14. Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain.
  15. Universitat Autònoma de Barcelona, Bellaterra, 08193 Cerdanyola del Vallès (Barcelona), Spain.
  16. Migrant Health Research Group, Institute for Infection and Immunity, St. George's, University of London, London, SW17 0RE London, United Kingdom.
  17. Department of Medicine Solna, Karolinska Institutet, Solnavägen 17177, Solna (Stockholm), Sweden.

PMID: 34230959 DOI: 10.1093/jtm/taab100

Abstract

BACKGROUND: 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 HIV, hepatitis B and C, active tuberculosis, Chagas disease, strongyloidiasis, and schistosomiasis, based on patient characteristics (including variables of country of origin, age, sex).

METHODS: A pragmatic pilot cluster-randomised 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 ISRCTN (ISRCTN14795012).

RESULTS: 15780 migrants registered across the 8 centres had at least one visit during the intervention period (March to 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 (OR:2.08 95%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 to 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).

CONCLUSIONS: 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.

© International Society of Travel Medicine 2021. Published by Oxford University Press.

Keywords: clinical decision support system; infectious disease; migrant; screening; software

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