Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
Med J Aust. 2013 Oct 7;199(7):485-9. doi: 10.5694/mja13.10133.
To identify factors that influence the extent to which general practitioners use absolute risk (AR) assessment in cardiovascular disease (CVD) risk assessment.
DESIGN, SETTING AND PARTICIPANTS: Semi-structured interviews with 25 currently practising GPs from eight Divisions of General Practice in New South Wales, Australia, between October 2011 and May 2012. Data were analysed using framework analysis.
The study identified five strategies that GPs use with patients in different situations, defined in terms of the extent to which AR was used and the reasons given for this: the AR-focused strategy, used when AR assessment was considered useful for the patient; the AR-adjusted strategy, used to account for additional risk factors such as family history; the clinical judgement strategy, used when GPs considered that their judgement took multiple risk factors into account as effectively as AR; the passive disregard strategy, used when GPs lacked sufficient time, access or experience to use AR; and the active disregard strategy, used when AR was considered to be inappropriate for the patient. The strategies were linked with different opportunity, capability and motivation barriers to the use of AR.
This study provides an in-depth insight into the factors that influence GPs' use of AR in CVD risk assessment. The results suggest that GPs use a range of strategies in different situations, so different approaches may be required to improve the use of AR guidelines in practice.
确定影响全科医生在心血管疾病（CVD）风险评估中使用绝对风险（AR）评估程度的因素。
设计、地点和参与者：2011 年 10 月至 2012 年 5 月，对澳大利亚新南威尔士州 8 个普通科医生分部的 25 名现任全科医生进行半结构式访谈。使用框架分析对数据进行分析。
该研究确定了全科医生在不同情况下与患者使用的五种策略，这些策略根据使用 AR 的程度和给出的原因来定义：AR 重点策略，用于 AR 评估对患者有用的情况；AR 调整策略，用于考虑家族史等其他风险因素；临床判断策略，用于全科医生认为他们的判断能够像 AR 一样有效地考虑多个风险因素；被动忽视策略，用于全科医生缺乏足够的时间、途径或经验来使用 AR；以及主动忽视策略，用于 AR 被认为不适合患者的情况。这些策略与使用 AR 的机会、能力和动机障碍有关。
本研究深入了解了影响全科医生在 CVD 风险评估中使用 AR 的因素。结果表明，全科医生在不同情况下使用多种策略，因此可能需要不同的方法来提高 AR 指南在实践中的应用。
