Primary care physicians’ perspectives on computer-based health risk assessment tools for chronic diseases: a mixed methods study

Background Health risk assessment tools compute an individual’s risk of developing a disease. Routine use of such tools by primary care physicians (PCPs) is potentially useful in chronic disease prevention. We sought physicians’ awareness and perceptions of the usefulness, usability and feasibility of performing assessments with computer-based risk assessment tools in primary care settings.Methods Focus groups and usability testing with a computer-based risk assessment tool were conducted with PCPs from both university-affiliated and community-based practices. Analysis was derived from grounded theory methodology.Results PCPs (n = 30) were aware of several risk assessment tools although only select tools were used routinely. The decision to use a tool depended on how use impacted practice workflow and whether the tool had credibility. Participants felt that embedding tools in the electronic medical records (EMRs) system might allow for health information from the medical record to auto-populate into the tool. User comprehension of risk could also be improved with computer-based interfaces that present risk in different formats.Conclusions In this study, PCPs chose to use certain tools more regularly because of usability and credibility. Despite there being differences in the particular tools a clinical practice used, there was general appreciation for the usefulness of tools for different clinical situations. Participants characterised particular features of an ideal tool, feeling strongly that embedding risk assessment tools in the EMR would maximise accessibility and use of the tool for chronic disease management. However, appropriate practice workflow integration and features that facilitate patient understanding at point-of-care are also essential.

Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care : a retrospective observational study

This study received funding through a grant by the North York Genera Hospital Foundation’s Exploration Fund. MG held an investigator award from the Department of Family and Community Medicine, University of Toronto and was supported by a research stipend from North York General Hospital. The Canadian Primary Care Sentinel Surveillance Network was a committee of the College of Family Physicians of Canada and was funded through a contribution agreement with the Public Health Agency of Canada.Objectives: To study systematic errors in recording blood pressure (BP) as measured by end digit preference (EDP); to determine associations between EDP, uptake of Automated Office BP (AOBP) machines and cardiovascular outcomes. Design: Retrospective observational study using routinely collected electronic medical record data from 2006 to 2015 and a survey on year of AOBP acquisition in Toronto, Canada in 2017. Setting: Primary care practices in Canada and the UK. Participants: Adults aged 18 years or more. Main outcome measures: Mean rates of EDP and change in rates. Rates of EDP following acquisition of an AOBP machine. Associations between site EDP levels and mean BP. Associations between site EDP levels and frequency of cardiovascular outcomes. Results:  707 227 patients in Canada and 1 558 471 patients in the UK were included. From 2006 to 2015, the mean rate of BP readings with both systolic and diastolic pressure ending in zero decreased from 26.6% to 15.4% in Canada and from 24.2% to 17.3% in the UK. Systolic BP readings ending in zero decreased from 41.8% to 32.5% in the 3 years following the purchase of an AOBP machine. Sites with high EDP had a mean systolic BP of 2.0 mm Hg in Canada, and 1.7 mm Hg in the UK, lower than sites with no or low EDP. Patients in sites with high levels of EDP had a higher frequency of stroke (standardised morbidity ratio (SMR) 1.15, 95% CI 1.12 to 1.17), myocardial infarction (SMR 1.16, 95% CI 1.14 to 1.19) and angina (SMR 1.25, 95% CI 1.22 to 1.28) than patients in sites with no or low EDP. Conclusions:  Acquisition of an AOBP machine was associated with a decrease in EDP levels. Sites with higher rates of EDP had lower mean BPs and a higher frequency of adverse cardiovascular outcomes. The routine use of manual office-based BP measurement should be reconsidered.Publisher PDFPeer reviewe

Family Physicians' Perspectives on Computer-based Health Risk Assessment Tools for Chronic Diseases

Health risk assessment tools compute an individual’s risk of developing a disease. They are potentially useful in chronic disease prevention mediated by family physicians. We sought to learn family physicians’ awareness, and perspectives on the usefulness, usability and feasibility of implementation of risk assessment tools. Focus groups, discussion with key informants, and usability testing with an EMR-embedded risk assessment tool were conducted with family physicians (n=30) from academic and community-based practices. Analysis following grounded theory methodology was used to generate categories and themes. Our findings indicate that participants are aware of the implications of risk assessment calculations though very few tools are used regularly. Tool integration with EMR systems was felt to be essential in assisting tool usability, uptake and efficiency of use. Results provide insight into current risk assessment tool use and the facilitation of wider implementation of risk assessment tools in family practice settings.MAS

Text mining describes the use of statistical and epidemiological methods in published medical research

Objective: To describe trends in the use of statistical and epidemiological methods in the medical literature over the past 2 decades.Study Design and Setting: We obtained all 1,028,786 articles from the PubMed Central Open-Access archive (retrieved May 9, 2015). We focused on 113,450 medical research articles. A Delphi panel identified 177 statistical/epidemiological methods pertinent to clinical researchers. We used a text-mining approach to determine if a specific statistical/epidemiological method was encountered in a given article. We report the proportion of articles using a specific method for the entire cross-sectional sample and also stratified into three blocks of time (1995-2005; 2006-2010; 2011-2015).Results: Numeric descriptive statistics were commonplace (96.4% articles). Other frequently encountered methods groups included statistical inferential concepts (52.9% articles), epidemiological measures of association (53.5% articles) methods for diagnostic/classification accuracy (40.1% articles), hypothesis testing (28.8% articles), ANOVA (23.2% articles), and regression (22.6% articles). We observed relative percent increases in the use of: regression (103.0%), missing data methods (217.9%), survival analysis (147.6%), and correlated data analysis (192.2%).Conclusions: This study identified commonly encountered and emergent methods used to investigate medical research problems. Clinical researchers must be aware of the methodological landscape in their field, as statistical/epidemiological methods underpin research claims.</p