Improving the management of people with a family history of breast cancer in primary care: before and after study of audit-based education

BMC Family Practice

Research Article

Mohammad Tahir¹  Tom Chan¹  Simon de Lusignan¹  Ibrahim Jubber²  Imran Rafi³  Susmita Chowdhury⁴ 

[1] Department of Healthcare Management and Policy, University of Surrey, GU2 7XH, Guildford, Surrey, UK;Division of Population Health Sciences and Education, St George’s, University of London, SW17 0RE, Cranmer Terrace, London, UK;Division of Population Health Sciences and Education, St George’s, University of London, SW17 0RE, Cranmer Terrace, London, UK;Clinical Innovation and Research Centre (CIRC), Royal College of General Practitioners, 30 Euston Square, NW1 2FB, London, UK;PHG Foundation, 2 Worts Causeway, CB1 8RN, Cambridge, Cambridgeshire, UK;

关键词: Breast Cancer;    Breast Cancer Risk;    Hormone Replacement Therapy;    Oral Contraceptive Pill;    General Practitioner;   

DOI  :  10.1186/1471-2296-14-105

 received in 2012-11-21, accepted in 2013-07-08,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundIn England, guidance from National Institute for Clinical Excellence (NICE) states women with a family history of breast cancer presenting to primary care should be reassured or referred.We reviewed the evidence for interventions that might be applied in primary care and conducted an audit of whether low risk women are correctly advised and flagged.MethodsWe conducted a literature review to identify modifiable risk factors. We extracted routinely collected data from the computerised medical record systems of 6 general practices (population approximately 30,000); of the variables identified in the guidance. We implemented a quality improvement (QI) intervention called audit-based education (ABE) comparing participant practices with guidelines and each other before and after; we report odds ratios (OR) of any change in data recording.ResultsThe review revealed evidence for advising on: diet, weight control, physical exercise, and alcohol. The proportion of patients with recordings of family history of: disease, neoplasms, and breast cancer were: 39.3%, 5.1% and 1.3% respectively. There was no significant change in the recording of family history of disease or cancer; OR 1.02 (95% CI 0.98-1.06); and 1.08 (95% CI 0.99-1.17) respectively. Recording of alcohol consumption and smoking both increased significantly; OR 1.36 (95% CI 1.30-1.43); and 1.42 (95% CI 1.27-1.60) respectively. Recording lifestyle advice fell; OR 0.84 (95% CI 0.81-0.88).ConclusionsThe study informs about current data recording and willingness to engage in ABE. Recording of risk factors improved after the intervention. Further QI is needed to achieve adherence to current guidance.

【 授权许可】

Unknown   
© Rafi et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.