在初级保健中评估慢性病家族史：患病率、记录情况及适当筛查
Assessing family history of chronic disease in primary care: Prevalence, documentation, and appropriate screening.
作者信息
Carroll June C, Campbell-Scherer Denise, Permaul Joanne A, Myers Jesse, Manca Donna P, Meaney Christopher, Moineddin Rahim, Grunfeld Eva
机构信息
Professor and Sydney G. Frankfort Chair in the Department of Family and Community Medicine of the Sinai Health System at the University of Toronto in Ontario.
Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
出版信息
Can Fam Physician. 2017 Jan;63(1):e58-e67.
OBJECTIVE
To assess the proportion of primary care patients who report a family history (FH) of type 2 diabetes, coronary artery disease, breast cancer, or colorectal cancer (CRC); assess concordance of FH information derived from the electronic medical record (EMR) compared with patient-completed health questionnaires; and assess whether appropriate screening was informed by risk based solely on FH.
DESIGN
Data from the BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) trial were used. Patients were mailed questionnaires. Baseline FH and screening data were obtained for enrolled patients from the EMR and health questionnaires.
SETTING
Ontario and Alberta.
PARTICIPANTS
Randomly selected patients from 8 family practices.
MAIN OUTCOME MEASURES
Agreement on FH between the EMR and questionnaire was determined; logistic regression was used to assess significant predictors of screening.
RESULTS
In total, 775 of 789 (98%) patients completed the health questionnaire. The mean age of participants was 52.5 years and 72% were female. A minimum of 12% of patients (range 12% to 36%) had a reported FH of 1 of 4 chronic diseases. Among patients with positive FH, the following proportions of patients had that FH recorded in the EMR compared with the questionnaire: diabetes, 24% in the EMR versus 36% on the questionnaire, κ = 0.466; coronary artery disease, 35% in the EMR versus 22% on the questionnaire, κ = 0.225; breast cancer, 21% in the EMR versus 22% on the questionnaire, κ = 0.241; and CRC, 12% in the EMR versus 14% on the questionnaire, κ = 0.510. There was moderate agreement for diabetes and CRC. The presence of FH was a significant predictor of CRC screening (odds ratio 1.9, 95% CI 1.1 to 3.1).
CONCLUSION
A moderate prevalence of FH was found for 4 conditions for which screening recommendations vary with risk based on FH. Having patients self-complete an FH was thought to be feasible; however, questions about FH accuracy and completeness from both self-report and EMR remain. Work is needed to determine how to facilitate the adoption of FH tools into practice as well as strategies linking familial risk to appropriate screening.Trial registration number ISRCTN07170460 (ISRCTN Registry).
目的
评估报告有2型糖尿病、冠状动脉疾病、乳腺癌或结直肠癌（CRC）家族史（FH）的基层医疗患者比例；评估从电子病历（EMR）中获取的FH信息与患者填写的健康问卷之间的一致性；并评估仅基于FH风险的筛查是否得当。
设计
使用了来自BETTER（基于现有工具改善基层医疗中的慢性病预防和筛查）试验的数据。向患者邮寄问卷。从EMR和健康问卷中获取登记患者的基线FH和筛查数据。
地点
安大略省和艾伯塔省。
参与者
从8个家庭医疗诊所中随机选择的患者。
主要观察指标
确定EMR与问卷之间FH的一致性；使用逻辑回归评估筛查的显著预测因素。
结果
总共789名患者中的775名（98%）完成了健康问卷。参与者的平均年龄为52.5岁，72%为女性。至少12%的患者（范围为12%至36%）报告有4种慢性病之一的FH。在FH呈阳性的患者中，与问卷相比，以下比例的患者在EMR中记录了该FH：糖尿病，EMR中为24%，问卷中为36%，κ = 0.466；冠状动脉疾病，EMR中为35%，问卷中为22%，κ = 0.225；乳腺癌，EMR中为21%，问卷中为22%，κ = 0.241；CRC，EMR中为12%，问卷中为14%，κ = 0.510。糖尿病和CRC存在中度一致性。FH的存在是CRC筛查的显著预测因素（比值比1.9，95%可信区间1.1至3.1）。
结论
发现4种疾病的FH患病率适中，对于这些疾病，筛查建议因基于FH的风险而异。让患者自行填写FH被认为是可行的；然而，关于自我报告和EMR中FH准确性和完整性的问题仍然存在。需要开展工作以确定如何促进FH工具在实践中的应用以及将家族风险与适当筛查相联系的策略。试验注册号ISRCTN07170460（ISRCTN注册库）。
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