Role of survey physicians: the Italian experience

Simona GiampaoliIstituto Superiore di SanitàRome, Italy

Physical examination (Seven Countries Study)

Mouth – number of teeth edentulousThyroid – presence of goiterHeart - soundsLung - murmursAbdomen - liverPulses – arms, legs, etc.Skin

Collection of symptoms and signsNo diagnosesOnly one person made diagnoses reviewing the papers, ECG, etc. (Menotti)

Health Examination Survey/ Osservatorio Epidemiologico

Cardiovascolare

20 centres, one per Region

OUR ACTIVITIES AT REGIONAL LEVELinform Health Local Authorities (General Director of the Hospital/District)involve Director of the Cardiology/Prevention/Medicine Unitinform GPs

Health Examination Survey/ Osservatorio

Epidemiologico Cardiovascolare

Tasks of the Director of Cardiology/Preventive/Medicine Unit:sign the letter of invitation and lab exam resultsselect the nurses employed in the screening nominate the leader of the group (nurse or young medical doctor)GOOD OPPORTUNITY TO TEACH EPIDEMIOLOGY AND HOW TO MEASURE RISK FACTORS IN A PREVENTIVE SETTING

Health Examination Survey/ Osservatorio

Epidemiologico Cardiovascolare

PROBLEMSNurses and physicians are used to medical emergencies requiring prompt intervention ,…… they are not used to work in preventive settings and to apply standardized procedures requiring specific time frame. Prevention requires time and willingness to talk to patientsUsually persons do not like to wait before blood drawing as they are fasting and uncomfortable with blood draw

Health Examination Survey/ Osservatorio

Epidemiologico Cardiovascolare

Roles of the survey physician• reviews and signs lab exams (ECG, spirometry, bone densitometry, laboratory tests)• results can be hand-delivered or sent by surface mail (systematic reviews have found that physician advices are associated with quitting smoking in 2% smokers )

Health Examination Survey/ Osservatorio

Epidemiologico CardiovascolareThe presence of a physician (GP)

increases participation rate

Health Examination Survey/ Osservatorio

Epidemiologico Cardiovascolare

Other limitations (convince physician to collect data using standardized procedures)Cost (select preferably physician in retirement)