Improving detection of familial hypercholesterolaemia in primary care using electronic audit and nurse-led clinics.
Improving detection of familial hypercholesterolaemia in primary care using electronic audit and nurse-led clinics.
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DOI：
10.1111/jep.12481
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发表时间：
2016-06
影响因子：
2.4
通讯作者：
Medway FH Audit Steering Committee
中科院分区：
文献类型：
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作者：
Green P;Neely D;Humphries SE;Medway FH Audit Steering Committee
在英国，只有不到15%的家族性高胆固醇血症（FH）病例被诊断出来，这是冠心病预防的一个主要差距。我们希望支持Medway临床调试组（CCG）内的初级保健医生实施NICE指南（CG 71），并考虑总胆固醇浓度升高的成人中FH的可能性，从而提高FH患者的检测。利用临床决策支持软件（Audit+），我们开发了一个FH审计工具，并在GP实践中对电子病历进行了系统审计，首先确定所有诊断为FH或可能FH的患者，然后电子标记记录的总胆固醇>7.5 mmol L−1或LDL‐C > 4.9 mmol L−1（成人）的患者，以进行进一步评估。2年后，引入了一个护士主导的诊所，以更密集地筛查新的FH指数病例。我们评估了这些干预措施是否增加了FH的患病率，使其更接近流行病学研究的预期患病率。Medway CCG中FH的基线患病率为0.13%（1/750人）。2年后，记录的确诊FH患病率增加了0.09%至0.22%（1/450人）。护士顾问计划持续了9个月（2013年10月至2014年7月），在此期间，记录的FH患者患病率增加至0.28%（357人中有1人），“有风险和未筛查”患者的患病率从0.58%降至0.14%。我们的研究表明，两个简单的干预措施增加了FH的检测。这一系统而简单的电子病例发现计划与护士主导的审查允许识别新的索引病例，使记录的检出疾病患病率增加一倍以上，达到1/357（0.28%）。这项研究表明，初级保健在识别患有这种疾病的患者方面发挥着重要作用。
In the UK fewer than 15% of familial hypercholesterolemia (FH) cases are diagnosed, representing a major gap in coronary heart disease prevention. We wished to support primary care doctors within the Medway Clinical Commissioning Group (CCG) to implement NICE guidance (CG71) and consider the possibility of FH in adults who have raised total cholesterol concentrations, thereby improving the detection of people with FH. Utilizing clinical decision support software (Audit+) we developed an FH Audit Tool and implemented a systematic audit of electronic medical records within GP practices, first identifying all patients diagnosed with FH or possible FH and next electronically flagging patients with a recorded total cholesterol of >7.5 mmol L−1 or LDL‐C > 4.9 mmol L−1 (in adults), for further assessment. After a 2‐year period, a nurse‐led clinic was introduced to screen more intensely for new FH index cases. We evaluated if these interventions increased the prevalence of FH closer to the expected prevalence from epidemiological studies. The baseline prevalence of FH within Medway CCG was 0.13% (1 in 750 persons). After 2 years, the recorded prevalence of diagnosed FH increased by 0.09% to 0.22% (1 in 450 persons). The nurse advisor programme ran for 9 months (October 2013–July 2014) and during this time, the recorded prevalence of patients diagnosed with FH increased to 0.28% (1 in 357 persons) and the prevalence of patients ‘at risk and unscreened’ reduced from 0.58% to 0.14%. Our study shows that two simple interventions increased the detection of FH. This systematic yet simple electronic case‐finding programme with nurse‐led review allowed the identification of new index cases, more than doubling the recorded prevalence of detected disease to 1 in 357 (0.28%). This study shows that primary care has an important role in identifying patients with this condition.