Division of Primary Care, University of Nottingham, Nottingham, UK.
BMC Health Serv Res. 2009 Oct 12;9:184. doi: 10.1186/1472-6963-9-184.
Coronary heart disease (CHD) is the leading cause of death in the developed world, and its prevention a core activity in current UK general practice. Currently, family history is not systematically integrated into cardiovascular risk assessment in the UK, Europe or the US. Further, primary health care professionals' lack the confidence to interpret family history information and there is a low level of recording of family history information in General Practice (GP) records. Primary prevention of CHD through lifestyle advice has sometimes yielded modest results although, for example, behavioural interventions targeted at "at risk" patients have produced encouraging findings. A family history approach, targeted at those requesting CHD assessment, could motivate lifestyle change. The project will assess the clinical value of incorporating systematic family history information into CHD risk assessment in primary care, from the perspective of the users of this service, the health care practitioners providing this service, and the National Health Service.
METHODS/DESIGN: The study will include three distinct phases: (1) cross-sectional survey to ascertain baseline information on current recording of family information; (2) through an exploratory matched-pair cluster randomised study, with nested qualitative semi-structured interview and focus group study, to assess the impact of systematic family history recording on participants' and primary care professionals' experience; (3) develop an economic model of the costs and benefits of incorporating family history into CHD risk assessment.
On completion of the project, users and primary care practitioners will be more informed of the value and utility of including family history in CHD risk assessment. Further, this approach will also act as a model of how familial risk information can be integrated within mainstream primary care preventive services for common chronic diseases.
Current Controlled Trials ISRCTN17943542.
冠心病（CHD）是发达国家的主要死因，预防冠心病是当前英国全科医学的核心活动。目前，在英国、欧洲和美国，家族史并没有被系统地纳入心血管风险评估中。此外，初级保健专业人员缺乏解读家族史信息的信心，全科医生记录家族史信息的水平也较低。尽管通过生活方式建议进行冠心病的一级预防有时效果甚微，但针对“高危”患者的行为干预却取得了令人鼓舞的结果。通过针对请求进行冠心病评估的人群进行家族史方法，可以促使生活方式发生改变。该项目将从服务使用者、提供服务的医疗保健专业人员以及国家卫生服务的角度评估将系统的家族史信息纳入初级保健中的冠心病风险评估中的临床价值。
方法/设计：该研究将包括三个不同阶段：（1）横断面调查，以确定当前记录家族史信息的基线信息；（2）通过探索性匹配对聚类随机研究，嵌套定性半结构访谈和焦点小组研究，评估系统家族史记录对参与者和初级保健专业人员体验的影响；（3）制定将家族史纳入冠心病风险评估的成本效益经济模型。
该项目完成后，使用者和初级保健医生将更了解将家族史纳入冠心病风险评估的价值和实用性。此外，这种方法还将成为如何在常见慢性疾病的主流初级保健预防服务中整合家族风险信息的模型。
当前对照试验 ISRCTN84625325。
