Feasibility of improving identification of familial hypercholesterolaemia in general practice: intervention development study
Feasibility of improving identification of familial hypercholesterolaemia in general practice: intervention development study
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DOI：
10.1136/bmjopen-2016-011734
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Kai, Joe
中科院分区：
文献类型：
--
作者：
Qureshi, Nadeem;Weng, Stephen;Kai, Joe
目的 评估在初级保健中改进家族性高胆固醇血症 (FH) 识别的可行性，以及收集结局指标为未来试验提供信息的可行性。设计可行性干预研究。在英格兰中部设置 6 个全科诊所 (GP)。通过搜索电子健康记录，确定了 831 名胆固醇升高>7.5mmol/L 的合格患者，以招募参与干预措施。实践中的干预教育课程；在咨询中使用机会性计算机提醒或在 6 个月内向受邀填写家族史调查问卷的合格患者发出普遍邮寄邀请。那些符合可能 FH 的 Simon-Broome 标准的患者被邀请进行全科医生评估，并转诊接受专家明确诊断。 结果衡量 招募符合条件的患者的比率、识别可能患有 FH 的患者、转诊至专科护理、在专科护理中诊断确诊的 FH；以及为未来试验收集相关结果指标的可行性。结果 在 173 个全科诊所中，18 个有兴趣参与，6 个被招募。从 831 名符合条件的患者中，招募了 127 名患者（15.3%）并完成了家族史调查问卷：其中 86 名（10.7%）通过邮寄邀请，41 名（4.9%）机会性填写。在 127 名患者中，32 名（25.6%）在初级保健中可能被诊断为 FH。在完成招募后6个月内，7名患者接受了专家评估，确认2名患者患有明确的FH（28.6％），5名患者患有可能的FH（71.4％）。仅使用从电子记录中自动提取数据来提取血脂测试、他汀类药物处方和高胆固醇血症次要原因的潜在试验结果指标，无需求助于其他方法。 结论 该干预措施在全科医生中实施是可行的，并有助于招募胆固醇升高的患者进行有针对性的评估和识别 FH。直接从电子记录中提取数据可用于评估未来试验中的相关结果指标。
Objectives To assess the feasibility of improving identification of familial hypercholesterolaemia (FH) in primary care, and of collecting outcome measures to inform a future trial.Design Feasibility intervention study.Setting 6 general practices (GPs) in central England.Participants 831 eligible patients with elevated cholesterol >7.5mmol/L were identified, by search of electronic health records, for recruitment to the intervention.Intervention Educational session in practice; use of opportunistic computer reminders in consultations or universal postal invitation over 6months to eligible patients invited to complete a family history questionnaire. Those fulfilling the Simon-Broome criteria for possible FH were invited for GP assessment and referred for specialist definitive diagnosis.Outcome measures Rates of recruitment of eligible patients, identification of patients with possible FH, referral to specialist care, diagnosis of confirmed FH in specialist care; and feasibility of collecting relevant outcome measures for a future trial.Results Of 173 general practices, 18 were interested in participating and 6 were recruited. From 831 eligible patients, 127 (15.3%) were recruited and completed family history questionnaires: 86 (10.7%) through postal invitation and 41 (4.9%) opportunistically. Among the 127 patients, 32 (25.6%) had a possible diagnosis of FH in primary care. Within 6months of completing recruitment, 7 patients had had specialist assessment confirming 2 patients with definite FH (28.6%), and 5 patients with possible FH (71.4%). Potential trial outcome measures for lipid tests, statin prescribing and secondary causes of hypercholesterolaemia were extracted using automated data extraction from electronic records alone without recourse to other methods.Conclusions The intervention is feasible to implement in GP, and facilitates recruitment of patients with raised cholesterol for targeted assessment and identification of FH. Extracting data directly from electronic records could be used to evaluate relevant outcome measures in a future trial.