Hutchison B, Birch S, Evans C E, Goldsmith L J, Markham B A, Frank J, Paterson M
Department of Family Medicine, Centre for Health Economics and Policy Analysis, McMaster University, Health Sciences Centre Room 3H1E, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5.
BMJ. 1998 Apr 18;316(7139):1208-13. doi: 10.1136/bmj.316.7139.1208.
To validate a self administered postal questionnaire appraising risk of coronary heart disease. To determine whether use of this questionnaire increased the percentage of people at high risk of coronary heart disease and decreased the percentage of people at low risk who had their cholesterol concentration measured.
Validation was by review of medical records and clinical assessment. The questionnaire appraising risk of coronary heart disease encouraged those meeting criteria for cholesterol measurement to have a cholesterol test and was tested in a randomised controlled trial. The intervention group was sent the risk appraisal questionnaire with a health questionnaire that determined risk of coronary heart disease without identifying the risk factors as related to coronary heart disease; the control group was sent the health questionnaire alone.
One capitation funded primary care practice in Canada with an enrolled patient population of about 12 000.
Random sample of 100 participants in the intervention and control groups were included in the validation exercise. 5686 contactable patients aged 20 to 69 years who on the basis of practice records had not had a cholesterol test performed during the preceding 5 years were included in the randomised controlled trial. 2837 were in the intervention group and 2849 were in the control group.
Sensitivity and specificity of assessment of risk of coronary heart disease with risk appraisal questionnaire. Rate of cholesterol testing during three months of follow up.
Sensitivity of questionnaire appraising coronary risk was 87.5% (95% confidence interval 73.2% to 95.8%) and specificity 91.7% (81.6% to 97.2%). Of the patients without pre-existing coronary heart disease who met predefined screening criteria based on risk, 45 out of 421 in the intervention group (10.7%) and 9 out of 504 in the control group (1.8%) had a cholesterol test performed during follow up (P<0.0001). Of the patients without a history of coronary heart disease who did not meet criteria for cholesterol testing, 30 out of 1128 in the intervention group (2.7%) and 18 out of 1099 in the control group (1.6%) had a cholesterol test (P=0.175). Of the patients with pre-existing coronary heart disease, 1 out of 15 in the intervention group (6.7%) and 1 out of 23 in the control group (4.3%) were tested during follow up (P=0.851, one tailed Fisher's exact test).
Although the questionnaire appraising coronary risk increased the percentage of people at high risk who obtained cholesterol testing, the effect was small. Most patients at risk who received the questionnaire did not respond by having a test.
验证一份用于评估冠心病风险的自填式邮政问卷。确定使用该问卷是否会增加冠心病高危人群的比例，并降低对胆固醇浓度进行检测的低危人群的比例。
通过审查病历和临床评估进行验证。评估冠心病风险的问卷鼓励符合胆固醇检测标准的人进行胆固醇检测，并在一项随机对照试验中进行了测试。干预组收到了风险评估问卷以及一份健康问卷，该健康问卷可确定冠心病风险，但未将风险因素与冠心病相关联；对照组仅收到健康问卷。
加拿大一家按人头付费的初级保健机构，登记患者约12000人。
干预组和对照组的100名参与者的随机样本被纳入验证工作。5686名年龄在20至69岁之间、根据机构记录在过去5年中未进行过胆固醇检测的可联系患者被纳入随机对照试验。干预组2837人，对照组2849人。
风险评估问卷评估冠心病风险的敏感性和特异性。随访三个月期间的胆固醇检测率。
评估冠心病风险问卷的敏感性为87.5%（95%置信区间73.2%至95.8%），特异性为91.7%（81.6%至97.2%）。在无冠心病病史且根据风险符合预定义筛查标准的患者中，干预组421人中有45人（10.7%），对照组504人中有9人（1.8%）在随访期间进行了胆固醇检测（P<0.0001）。在无冠心病病史且不符合胆固醇检测标准的患者中，干预组1128人中有30人（2.7%），对照组1099人中有18人（1.6%）进行了胆固醇检测（P=0.175）。在有冠心病病史的患者中，干预组15人中有1人（6.7%），对照组23人中有1人（4.3%）在随访期间接受了检测（P=0.851，单尾Fisher精确检验）。
尽管评估冠心病风险的问卷增加了进行胆固醇检测的高危人群的比例，但效果较小。大多数收到问卷的高危患者并未通过检测做出回应。
