Absolute risk assessment in general practice – a pilot study to measure impact on prescribing and adherence to guidelines
Project Status
Completed
Chief Investigators
Sanjyot Vagholkar
Associate Investigators
Nicholas Zwar, Mark Harris
Other team members
Iqbal Hasan, Qing Wan
Rationale
Prevention of cardiovascular disease (CVD) is a priority for the Australian community and general practitioners (GPs) play a key role in this activity. Effective prevention requires accurate assessment of a patient’s risk of developing CVD and appropriate management, which may include prescribing of medications. Appropriate prescribing of these medications is important, both for patient management and the pharmaceutical budget however research to date shows that prescribing practices do not always adhere to guidelines.
Current hypertension and lipid management guidelines recommend that doctors use an absolute risk assessment (ARA) tool when assessing and managing patients’ CV risk. AR is the probability of developing a CV event over a given time period, usually 5 or 10 years and takes into account the multifactorial causation of CVD. At present the use of ARA in general practice is limited. There have been no trials in Australia looking at the impact of ARA on patient management and prescribing in general practice.
Aims
This study aims to test the impact of ARA in general practice on prescribing of anti-hypertensive and lipid-lowering medications and adherence to guidelines.
Objectives:
To test the impact of ARA on prescribing of antihypertensive and lipid-lowering medications
To develop and pilot test tools which will measure changes in pharmacological and non-pharmacological management of CV risk
To develop a systematic method of comparing patient management with Australian hypertension and lipid guidelines
Design and Method
This is a before and after study where the intervention is an ARA of the patient by their GP. The study involves 6 GPs and aims to recruit 5 patients per GP.
Patient recruitment
GPs’ electronic records will be searched for patients in the age group of interest and by exclusion of those with recorded CV events. Patients will be invited to participate by mail.
Inclusion criteria
1. Age 45-69
2. No previous CV event
3. Speak English
4. Not cognitively impaired
Patients who provide written consent will then be asked to have a blood test for lipids and glucose and make an appointment for an AR consultation with their GP.
Intervention
Participating GPs will be provided with training about ARA, how to use it in the clinical consultation and recommended management of CV risk based on current guidelines. Printed resources and both paper and electronic copies of the NZ calculator will be provided.
Following training GPs will conduct AR consultations with the participating patients. Follow-up will be determined by the GP based on clinical management decisions.
Data collection
Baseline and 3 month post-intervention data will be collected by patient questionnaire and medical record audit. Semi-structured interviews will be conducted with participating GPs and a sample of patients at the end of the study.
Study outcomes
1. Changes in prescribing of anti-hypertensive and lipid lowering medications
2. Changes in management of lifestyle risk factors of smoking, diet and physical activity
3. Adherence of management to Australian guidelines
