چکیده (انگلیسی):

Background:Guidelines on cardiovascular disease (CVD) risk reassessment intervals are unclear, potentially leading
to detrimental practice variation: too frequent can result in overtreatment and greater strain on the healthcare
system; too infrequent could result in the neglect of high risk patients who require medication. This study aimed
to understand the different factors that general practitioners (GPs) consider when deciding on the reassessment
interval for patients previously assessed for primary CVD risk.
Methods:This paper combines quantitative and qualitative data regarding reassessment intervals from two
separate studies of CVD risk management. Experimental study: 144 Australian GPs viewed a random selection of
hypothetical cases via a paper-based questionnaire, in which blood pressure, cholesterol and 5-year absolute risk
(AR) were systematically varied to appear lower or higher. GPs were asked how they would manage each case,
including an open-ended response for when they would reassess the patient. Interview study: Semi-structured
interviews were conducted with a purposive sample of 25 Australian GPs, recruited separately from the GPs in the
experimental study. Transcribed audio-recordings were thematically coded, using the Framework Analysis method.
Results:Experiment: GPs stated that they would reassess the majority of patients across all absolute risk categories
in 6 months or less (low AR = 52 % [CI95%=47–57 %], moderate AR = 82 % [CI95%=76–86 %], high AR = 87 %
[CI95%=82–90 %], total = 71 % [CI95%=67–75 %]), with 48 % (CI95%=43–53 %) of patients reassessed in under
3 months. The majority (75 % [CI95%=70–79 %]) of patients with low-moderate AR (≤15 %) and an elevated risk
factor would be reassessed in under 6 months.
Interviews: GPs identified different functions for reassessment and risk factor monitoring, which affected recommended
intervals. These included perceived psychosocial benefits to patients, preparing the patient for medication, and
identifying barriers to lifestyle change and medication adherence. Reassessment and monitoring intervals were driven
by patient motivation to change lifestyle, patient demand, individual risk factors, and GP attitudes.
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* Correspondence:kirsten.mccaffery@sydney.edu.au
1
Screening and Test Evaluation Program (STEP), Sydney School of Public
Health, The University of Sydney, Sydney, NSW, Australia
2
Centre for Medical Psychology & Evidence-based Decision-making
(CeMPED), The University of Sydney, Sydney, NSW, Australia
Full list of author information is available at the end of the article
© 2016 The Author(s).Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
McKinnet al. BMC Family Practice (2016) 17:107
DOI 10.1186/s12875-016-0499-7
(Continued from previous page)
Conclusions:There is substantial variation in reassessment intervals for patients with the same risk profile. This
suggests that GPs are not following reassessment recommendations in the Australian guidelines. The use of shorter
intervals for low-moderate AR contradicts research on optimal monitoring intervals, and may result in unnecessary
costs and over-treatment.