Effect of Adding Systematic Family History Enquiry to Cardiovascular Disease Risk Assessment in Primary Care

Qureshi, Nadeem; Armstrong, Sarah; Dhiman, Paula; Saukko, Paula; Middlemass, Joan; Evans, Philip; Kai, Joe

doi:10.7326/0003-4819-156-4-201202210-00002

Cited by 97 publications

(77 citation statements)

References 41 publications

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“…12, 28 The results of this pilot trial suggest that each of the three electronic portals has the capacity to increase the availability of valid family health history in the EHR.…”

Section: Discussionmentioning

confidence: 93%

“…[1][2][3][4][5][6][7] Electronic tools for patients may facilitate the collection of these data so that providers have more time to discuss preventive health care consequences. 8 Several factors are converging to drive interest in the adoption of effective and efficient systems for obtaining electronic data for family history from patients, including financial incentives for the "meaningful use" of electronic health records (EHRs), 9 new evidence for the clinical utility of family history, 10 and the growing use of genomics. 11 A recent report by Qureshi confirmed that adding family history improves the identification of persons with high cardiovascular risk in primary care practice.…”

Section: Introductionmentioning

confidence: 99%

“…11 A recent report by Qureshi confirmed that adding family history improves the identification of persons with high cardiovascular risk in primary care practice. 10 The use of DNA based screening will require family history in order to interpret rare sequence variations. 12 This paper reports on work to compare the rates of documentation of family health history and the validity of data provided by three different electronic portals compared to "usual care," in a pilot trial.…”

Section: Introductionmentioning

confidence: 99%

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Comparing Electronic Health Record Portals to Obtain Patient-Entered Family Health History in Primary Care

et al. 2013

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BACKGROUND: There is growing interest in developing systems to overcome barriers for acquiring and interpreting family health histories in primary care. OBJECTIVE: To examine the capacity of three different electronic portals to collect family history from patients and deposit valid data in an electronic health record (EHR). DESIGN: Pilot trial. PARTICIPANTS, INTERVENTION: Patients were enrolled from four primary care practices and were asked to collect family health history before a physical exam using either telephone-based interactive voice response (IVR) technology, a secure internet portal, or a waiting room laptop computer, with portal assigned by practice. Intervention practices were compared to a "usual care" practice, where there was no standard workflow to document family history (663 participants in the three intervention arms were compared to 296 participants from the control practice). MAIN MEASURES: New documentation of any family history in a coded EHR field within 30 days of the visit. Secondary outcomes included participation rates and validity. KEY RESULTS: Demographics varied by clinic. Documentation of new family history data was significantly higher, but modest, in each of the three intervention clinics (7.5 % for IVR clinic, 20.3 % for laptop clinic, and 23.1 % for patient portal clinic) versus the control clinic (1.7 %). Patient-entered data on common conditions in first degree relatives was confirmed as valid by a genetic counselor for the majority of cases (ranging from 64 to 82 % in the different arms). CONCLUSIONS: Within primary care practices, valid patient entered family health history data can be obtained electronically at higher rates than a standard of care that depends on provider-entered data. Further research is needed to determine how best to match different portals to individual patient preference, how the tools can best be integrated with provider workflow, and to assess how they impact the use of screening and prevention.KEY WORDS: family health history; electronic health record; EHR; provider-entered data.

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“…12, 28 The results of this pilot trial suggest that each of the three electronic portals has the capacity to increase the availability of valid family health history in the EHR.…”

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparing Electronic Health Record Portals to Obtain Patient-Entered Family Health History in Primary Care

et al. 2013

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“…11 One study did show that automated collection of family history can identify more patients at risk for heart disease, but it did not go on to demonstrate improved patient care outcomes from the availability of such information. 47 More studies that examine the clinical utility of family history, including the best way to engage PCPs in using this information are needed before we begin to use automated prompts and alerts for high-risk family histories.…”

Section: Resultsmentioning

confidence: 99%

Prompting Primary Care Providers about Increased Patient Risk As a Result of Family History: Does It Work?

Zazove

Plegue

Uhlmann

et al. 2015

The Journal of the American Board of Family Medicine

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Background: Electronic health records have the potential to facilitate family history use by primary care physicians (PCPs) to provide personalized care. The objective of this study was to determine whether automated, at-the-visit tailored prompts about family history risk change PCP behavior.Methods: Automated, tailored prompts highlighting familial risk for heart disease, stroke, diabetes, and breast, colorectal, or ovarian cancer were implemented during 2011 to 2012. Medical records of a cohort of community-based primary care patients, aged 35 to 65 years, who previously participated in our Family Healthware study and had a moderate or strong familial risk for any of the 6 diseases were subsequently reviewed. The main outcome measures were PCP response to the prompts, adding family history risk to problem summary lists, and patient screening status for each disease.Results: The 492 eligible patients had 847 visits during the study period; 152 visits had no documentation of response to a family history prompt. Of the remaining 695 visits, physician responses were reviewed family history (n ‫؍‬ 372, 53.5%), discussed family history (n ‫؍‬ 159, 22.9%), not addressed (n ‫؍‬ 155, 22.3%), and reviewed family history and ordered tests/referrals (n ‫؍‬ 5, 0.7%). There was no significant change in problem summary list documentation of risk status or screening interventions for any of the 6 diseases.Conclusions: No change occurred upon instituting simple, at-the-visit family history prompts geared to improve PCPs' ability to identify patients at high risk for 6 common conditions. The results are both surprising and disappointing. Further studies should examine physicians' perception of the utility of prompts for family history risk. (J Am Board Fam Med 2015;28:334 -342.)

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“…The ADDFAM (Added Value of ADDing FAMily History) cluster randomised trial, set in England, has recently demonstrated the utility of adding systematic family history enquiry to primary care cardiovascular disease risk assessment. 24,25 Other studies have also suggested that simple tools can correctly identify the majority of people with a significant family history of coronary heart disease or diabetes, 26 or colorectal cancer, 27 when compared with a detailed questionnaire. Using brief questionnaires to identify people at higher risk of other diseases such as depression has been established primary care practice for some time.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Development and evaluation of a brief self-completed family history screening tool for common chronic disease prevention in primary care

Walter¹,

Prevost²,

Birt³

et al. 2013

Br J Gen Pract

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Effect of Adding Systematic Family History Enquiry to Cardiovascular Disease Risk Assessment in Primary Care

Abstract: Genetics Health Services Research program of the United Kingdom Department of Health.

Cited by 97 publications

References 41 publications

Comparing Electronic Health Record Portals to Obtain Patient-Entered Family Health History in Primary Care

Comparing Electronic Health Record Portals to Obtain Patient-Entered Family Health History in Primary Care

Prompting Primary Care Providers about Increased Patient Risk As a Result of Family History: Does It Work?

Development and evaluation of a brief self-completed family history screening tool for common chronic disease prevention in primary care

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