GPs' and physicians' interpretation of risks, benefits and diagnostic test results
GPs' and physicians' interpretation of risks, benefits and diagnostic test results
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DOI：
10.1093/fampra/cmh209
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发表时间：
2004-04-01
期刊：
影响因子：
2.2
通讯作者：
McElduff, P
中科院分区：
文献类型：
--
作者：
Heller, RF;Sandars, JE;McElduff, P
背景了解预测试概率和基线风险有助于解释诊断测试的结果和治疗的益处，但对这些概念的理解有多好？目标.我们的目的是评估全科医生和顾问医生做出准确估计的能力，并了解两种常见临床状况的预检验概率和基线风险的应用。根据心绞痛和充血性心力衰竭患者的病例情景，对202名医生进行了两阶段问卷调查，随机选择了英格兰西北部皇家医师学院的成员，从西北部卫生当局的实践列表中随机选择了205名全科医生和128名参加检查员会议的MRCGP检查员。这些小组中分别有115、106和81名成员对第一阶段作出答复，44、46和64名成员对第二阶段作出答复。主要的结局指标是真实缺血性心脏病（IHD）存在的可能性和预测的1年死亡率;改变患病率和基线风险对这些结果的影响;以及对不同风险呈现方法的解释。试验前IHD发生概率的估计值范围为5 - 100%，1年死亡率的基线风险为0 - 86%。更多的全科医生检查员和顾问医生了解增加年龄对测试结果的影响，而不是随机抽样的全科医生。每组中的大多数人都正确地说，年龄的增加会减少需要治疗的人数（NNT）。与NNT或人群影响指标相比，将获益作为相对风险降低来介绍是开始治疗的更大刺激因素。临床医生应收集数据，以便更好地了解患者群体患病的可能性和基线风险。应探索方法，以增加对预测试概率对诊断测试结果的影响的理解，以及如何量化和证明干预措施的益处的影响。
Background. Understanding pre-test probability and baseline risks helps to interpret the results of diagnostic tests and the benefits of treatment, but how good is the understanding of these concepts?Objectives. Our aim was to assess the ability of GPs and consultant physicians to make accurate estimates and understand the application of pre-test probability and baseline risk for two common clinical conditions.Methods. A two-stage questionnaire survey based on case scenarios of patients with angina and congestive heart failure was carried out of 202 physicians, randomly selected from the members of the Royal College of Physicians in the NW of England, 205 GPs randomly chosen from the practice list of the NW Health Authorities and 128 MRCGP examiners attending an examiners meeting. A total of 115, 106 and 81 members of these groups, respectively, responded to the first stage, and 44, 46 and 64 to the second. The main outcome measures were the stated likelihood of true ischaemic heart disease (IHD) being present and the predicted 1-year mortality; the impact of changing prevalence and baseline risk on these results; and interpretation of different methods of risk presentation.Results. Estimates of pre-test probability of IHD being present ranged from 5 to 100% and of baseline risk of 1-year mortality from 0 to 86%. More GP examiners and consultant physicians understood the impact of increasing age on the test result than did the random sample of GPs. A majority of each group correctly said that increasing age would reduce the number needed to treat (NNT). Presentation of benefit as relative risk reduction was a greater stimulus to starting treatment than the NNT or measures of population impact.Conclusion. Clinicians should collect data to allow a better knowledge of the likelihood of disease and of baseline risk in their patient populations. Methods to increase the understanding of the influence of pre-test probability on diagnostic test results and of how to quantify and demonstrate the impact of the benefit of interventions should be explored.