18 Aug Targeted Case Finding Through EHR Starts More High Risk Patients On Treatment
MedicalResearch.com Interview with:
Tom Marshall, PhD, MRCGP, FFPH
Professor of public health and primary care
Institute of Applied Health Research
University of Birmingham
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Shortly before the Health Checks programme began, a programme of targeted case finding was set up in Sandwell in the West Midlands. In general practices in the area a programme nurse searched electronic medical records to identify untreated patients at high risk of cardiovascular disease. The nurse then invited high risk patients for assessment in the practice and those who needed treatment were referred to their GP for further action.
This was implemented in stages across 26 general practices, allowing it to be evaluated as a stepped wedge randomised controlled trial. The programme was successful, resulting in a 15.5% increase in the number of untreated high risk patients started on either antihypertensives or statins.
MedicalResearch.com: What should readers take away from your report?
Response: Untargeted health checks offered to all adults will only be effective if enough additional high-risk patients are identified and start treatment. We demonstrated that it is possible to pre-select high-risk patients for health checks using information in electronic patient records. We demonstrated that a dedicated nurse (or other clinician) inviting and assessing patients resulted in more high risk patients starting treatment. Because we don’t know if untargeted case finding (such as Health Checks) works we should adopt a targeted approach to case finding.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Advocates of untargeted Health Checks without a dedicated clinician focused on assessing and treating patients need to demonstrate their approach works. Until they do there is only evidence for targeted case finding.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Targeted case finding in the prevention of cardiovascular disease: a stepped wedge cluster randomised controlled trial
Karla Hemming, Ronan Ryan, Paramjit Gill, Paul Westerby, Kate Jolly, Tom Marshall
DOI: 10.3399/bjgp16X686629 Published 16 August 2016
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