Prompting primary care providers about increased patient risk as a result of family history: Does It work?

Philip Zazove, Melissa A. Plegue, Wendy R. Uhlmann, Mack Ruffin

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Electronic health records have the potential to facilitate family history use by primary care physicians (PCPs) to provide personalized care. The objective of this study was to determine whether automated, at-the-visit tailored prompts about family history risk change PCP behavior. Methods: Automated, tailored prompts highlighting familial risk for heart disease, stroke, diabetes, and breast, colorectal, or ovarian cancer were implemented during 2011 to 2012. Medical records of a cohort of community-based primary care patients, aged 35 to 65 years, who previously participated in our Family Healthware study and had a moderate or strong familial risk for any of the 6 diseases were subsequently reviewed. The main outcome measures were PCP response to the prompts, adding family history risk to problem summary lists, and patient screening status for each disease. Results: The 492 eligible patients had 847 visits during the study period; 152 visits had no documentation of response to a family history prompt. Of the remaining 695 visits, physician responses were reviewed family history (n = 372, 53.5%), discussed family history (n = 159, 22.9%), not addressed (n = 155, 22.3%), and reviewed family history and ordered tests/referrals (n = 5, 0.7%). There was no significant change in problem summary list documentation of risk status or screening interventions for any of the 6 diseases. Conclusions: No change occurred upon instituting simple, at-the-visit family history prompts geared to improve PCPs' ability to identify patients at high risk for 6 common conditions. The results are both surprising and disappointing. Further studies should examine physicians' perception of the utility of prompts for family history risk.

Original languageEnglish (US)
Pages (from-to)334-342
Number of pages9
JournalJournal of the American Board of Family Medicine
Volume28
Issue number3
DOIs
StatePublished - May 1 2015

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Primary Health Care
Primary Care Physicians
Documentation
Physicians
Aptitude
Electronic Health Records
Ovarian Neoplasms
Medical Records
Colorectal Neoplasms
Heart Diseases
Referral and Consultation
Stroke
Outcome Assessment (Health Care)
Breast Neoplasms

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health
  • Family Practice

Cite this

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title = "Prompting primary care providers about increased patient risk as a result of family history: Does It work?",
abstract = "Background: Electronic health records have the potential to facilitate family history use by primary care physicians (PCPs) to provide personalized care. The objective of this study was to determine whether automated, at-the-visit tailored prompts about family history risk change PCP behavior. Methods: Automated, tailored prompts highlighting familial risk for heart disease, stroke, diabetes, and breast, colorectal, or ovarian cancer were implemented during 2011 to 2012. Medical records of a cohort of community-based primary care patients, aged 35 to 65 years, who previously participated in our Family Healthware study and had a moderate or strong familial risk for any of the 6 diseases were subsequently reviewed. The main outcome measures were PCP response to the prompts, adding family history risk to problem summary lists, and patient screening status for each disease. Results: The 492 eligible patients had 847 visits during the study period; 152 visits had no documentation of response to a family history prompt. Of the remaining 695 visits, physician responses were reviewed family history (n = 372, 53.5{\%}), discussed family history (n = 159, 22.9{\%}), not addressed (n = 155, 22.3{\%}), and reviewed family history and ordered tests/referrals (n = 5, 0.7{\%}). There was no significant change in problem summary list documentation of risk status or screening interventions for any of the 6 diseases. Conclusions: No change occurred upon instituting simple, at-the-visit family history prompts geared to improve PCPs' ability to identify patients at high risk for 6 common conditions. The results are both surprising and disappointing. Further studies should examine physicians' perception of the utility of prompts for family history risk.",
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Prompting primary care providers about increased patient risk as a result of family history : Does It work? / Zazove, Philip; Plegue, Melissa A.; Uhlmann, Wendy R.; Ruffin, Mack.

In: Journal of the American Board of Family Medicine, Vol. 28, No. 3, 01.05.2015, p. 334-342.

Research output: Contribution to journalArticle

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T1 - Prompting primary care providers about increased patient risk as a result of family history

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AU - Plegue, Melissa A.

AU - Uhlmann, Wendy R.

AU - Ruffin, Mack

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N2 - Background: Electronic health records have the potential to facilitate family history use by primary care physicians (PCPs) to provide personalized care. The objective of this study was to determine whether automated, at-the-visit tailored prompts about family history risk change PCP behavior. Methods: Automated, tailored prompts highlighting familial risk for heart disease, stroke, diabetes, and breast, colorectal, or ovarian cancer were implemented during 2011 to 2012. Medical records of a cohort of community-based primary care patients, aged 35 to 65 years, who previously participated in our Family Healthware study and had a moderate or strong familial risk for any of the 6 diseases were subsequently reviewed. The main outcome measures were PCP response to the prompts, adding family history risk to problem summary lists, and patient screening status for each disease. Results: The 492 eligible patients had 847 visits during the study period; 152 visits had no documentation of response to a family history prompt. Of the remaining 695 visits, physician responses were reviewed family history (n = 372, 53.5%), discussed family history (n = 159, 22.9%), not addressed (n = 155, 22.3%), and reviewed family history and ordered tests/referrals (n = 5, 0.7%). There was no significant change in problem summary list documentation of risk status or screening interventions for any of the 6 diseases. Conclusions: No change occurred upon instituting simple, at-the-visit family history prompts geared to improve PCPs' ability to identify patients at high risk for 6 common conditions. The results are both surprising and disappointing. Further studies should examine physicians' perception of the utility of prompts for family history risk.

AB - Background: Electronic health records have the potential to facilitate family history use by primary care physicians (PCPs) to provide personalized care. The objective of this study was to determine whether automated, at-the-visit tailored prompts about family history risk change PCP behavior. Methods: Automated, tailored prompts highlighting familial risk for heart disease, stroke, diabetes, and breast, colorectal, or ovarian cancer were implemented during 2011 to 2012. Medical records of a cohort of community-based primary care patients, aged 35 to 65 years, who previously participated in our Family Healthware study and had a moderate or strong familial risk for any of the 6 diseases were subsequently reviewed. The main outcome measures were PCP response to the prompts, adding family history risk to problem summary lists, and patient screening status for each disease. Results: The 492 eligible patients had 847 visits during the study period; 152 visits had no documentation of response to a family history prompt. Of the remaining 695 visits, physician responses were reviewed family history (n = 372, 53.5%), discussed family history (n = 159, 22.9%), not addressed (n = 155, 22.3%), and reviewed family history and ordered tests/referrals (n = 5, 0.7%). There was no significant change in problem summary list documentation of risk status or screening interventions for any of the 6 diseases. Conclusions: No change occurred upon instituting simple, at-the-visit family history prompts geared to improve PCPs' ability to identify patients at high risk for 6 common conditions. The results are both surprising and disappointing. Further studies should examine physicians' perception of the utility of prompts for family history risk.

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