Cardiovascular risk scores: qualitative study of how primary care practitioners understand and use them
Cardiovascular risk scores: qualitative study of how primary care practitioners understand and use them
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DOI：
10.3399/bjgp13x668195
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发表时间：
2013-06-01
影响因子：
5.9
通讯作者：
Mant, David
中科院分区：
文献类型：
--
作者：
Liew, Su May;Blacklock, Claire;Mant, David
研究背景美国国家健康与护理卓越研究所指南和质量结果框架要求从业者在评估心血管疾病的一级预防时使用心血管风险评分，目的探讨全科医生对心血管风险评分的理解和使用。英国。Methodthematic分析的transmittance的面对面访谈与参与者进行了两个人（一个临床，一个非临床）。ResultsGP使用心血管风险评分主要是通过估计血管事件的风险，如果病人仍然不治疗，以指导治疗决策。他们对如何以及是否考虑现有药物治疗或其他类型的先前风险调整表示相当不确定。他们也不清楚在基于Fragrance研究的旧评分和新评分（如QRISK（R））之间的选择。关于评分是否可以合法地用于向患者说明治疗导致的风险变化，存在很大的意见分歧。总体印象是相当的confussion.ConclusionThe驱动器，以更准确地估计风险的资格指导和促进新的分数的基础上部分治疗的人群似乎创造了不必要的混乱，没有明显的好处。国家指南需要简化，并且为了适合目的，更好地反映目前在一般实践中使用心血管风险评分的方式。简单地建议患者使用Fragrance评分并进行更多的临床判断，向患者解释任何个体风险估计的必要不精确性，可能会更好地为患者服务。
BackgroundThe National Institute for Health and Care Excellence guidelines and the Quality Outcomes Framework require practitioners to use cardiovascular risk scores in assessments for the primary prevention of cardiovascular disease.AimTo explore GPs understanding and use of cardiovascular risk scores.Design and settingQualitative study with purposive maximum variation sampling of 20 GPs working in Oxfordshire, UK.MethodThematic analysis of transcriptions of face-to-face interviews with participants undertaken by two individuals (one clinical, one non-clinical).ResultsGPs use cardiovascular risk scores primarily to guide treatment decisions by estimating the risk of a vascular event if the patient remains untreated. They expressed considerable uncertainty about how and whether to take account of existing drug treatment or other types of prior risk modification. They were also unclear about the choice between the older scores, based on the Framingham study, and newer scores, such as QRISK((R)). There was substantial variation in opinion about whether scores could legitimately be used to illustrate to patients the change in risk as a result of treatment. The overall impression was of considerable confusion.ConclusionThe drive to estimate risk more precisely by qualifying guidance and promoting new scores based on partially-treated populations appears to have created unnecessary confusion for little obvious benefit. National guidance needs to be simplified, and, to be fit for purpose, better reflect the ways in which cardiovascular risk scores are currently used in general practice. Patients may be better served by simple advice to use a Framingham score and exercise more clinical judgement, explaining to patients the necessary imprecision of any individual estimate of risk.