Factors influencing general practitioners’ decisions about cardiovascular disease risk reassessment: findings from experimental and interview studies

BMC Family Practice

Research Article

Armando Teixeira-Pinto¹  Les Irwig¹  Shannon McKinn²  Carissa Bonner²  Jesse Jansen²  Kirsten McCaffery²  Matthew So²  Jenny Doust³  Paul Glasziou³ 

[1] Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia;Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia;Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia;Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia;Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia;

关键词: Cardiovascular disease;    Primary care;    General practice;    Prevention;    Risk assessment;   

DOI  :  10.1186/s12875-016-0499-7

 received in 2015-12-06, accepted in 2016-07-21,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundGuidelines on cardiovascular disease (CVD) risk reassessment intervals are unclear, potentially leading to detrimental practice variation: too frequent can result in overtreatment and greater strain on the healthcare system; too infrequent could result in the neglect of high risk patients who require medication. This study aimed to understand the different factors that general practitioners (GPs) consider when deciding on the reassessment interval for patients previously assessed for primary CVD risk.MethodsThis paper combines quantitative and qualitative data regarding reassessment intervals from two separate studies of CVD risk management. Experimental study: 144 Australian GPs viewed a random selection of hypothetical cases via a paper-based questionnaire, in which blood pressure, cholesterol and 5-year absolute risk (AR) were systematically varied to appear lower or higher. GPs were asked how they would manage each case, including an open-ended response for when they would reassess the patient. Interview study: Semi-structured interviews were conducted with a purposive sample of 25 Australian GPs, recruited separately from the GPs in the experimental study. Transcribed audio-recordings were thematically coded, using the Framework Analysis method.ResultsExperiment: GPs stated that they would reassess the majority of patients across all absolute risk categories in 6 months or less (low AR = 52 % [CI95% = 47–57 %], moderate AR = 82 % [CI95% = 76–86 %], high AR = 87 % [CI95% = 82–90 %], total = 71 % [CI95% = 67–75 %]), with 48 % (CI95% = 43–53 %) of patients reassessed in under 3 months. The majority (75 % [CI95% = 70–79 %]) of patients with low-moderate AR (≤15 %) and an elevated risk factor would be reassessed in under 6 months.Interviews: GPs identified different functions for reassessment and risk factor monitoring, which affected recommended intervals. These included perceived psychosocial benefits to patients, preparing the patient for medication, and identifying barriers to lifestyle change and medication adherence. Reassessment and monitoring intervals were driven by patient motivation to change lifestyle, patient demand, individual risk factors, and GP attitudes.ConclusionsThere is substantial variation in reassessment intervals for patients with the same risk profile. This suggests that GPs are not following reassessment recommendations in the Australian guidelines. The use of shorter intervals for low-moderate AR contradicts research on optimal monitoring intervals, and may result in unnecessary costs and over-treatment.

【 授权许可】

CC BY   
© The Author(s). 2016