title: Using disease risk estimates to guide risk factor interventions: field test of a patient workbook for self-assessing coronary risk.
abstract: OBJECTIVE
  To assess the feasibility and acceptability of a patient workbook for self-assessing coronary risk.
  
  
  METHODS
  Pilot study, with post-study physician and patient interviews.
  
  
  METHODS
  Twenty southern Ontario family doctors and 40 patients for whom they would have used the workbook under normal practice conditions.
  
  
  METHODS
  The study involved convening two sequential groups of family physicians: the first (n=10) attended focus group meetings to help develop the workbook (using algorithms from the Framingham Heart Study); the second (n=20) used the workbook in practice with 40 patients. Follow-up interviews were by interviewer-administered questionnaire.
  
  
  METHODS
  Physicians' and patients' opinions of the workbook's format, content, helpfulness, feasibility, and potential for broad application, as well as patients' perceived 10-year risk of a coronary event measured before and after using the workbook.
  
  
  RESULTS
  It took an average of 18 minutes of physician time to use the workbook: roughly 7 minutes to introduce it to patients, and about 11 minutes to discuss the results. Assessments of the workbook were generally favourable. Most patients were able to complete it on their own (78%), felt they had learned something (80%) and were willing to recommend it to someone else (98%). Similarly, 19 of 20 physicians found it helpful and would use it in practice with an average of 18% of their patients (range: 1-80%). The workbook helped to correct misperceptions patients had about their personal risk of a coronary event over the next 10 years (pre-workbook (mean (SD) %): 35.2 (16.9) vs. post-workbook: 17.3 (13.5), P < 0.0001; estimate according to algorithm: 10.6 (7.6)).
  
  
  CONCLUSIONS
  Given a simple tool, patients can and will assess their own risk of CHD. Such tools could help inform otherwise healthy individuals that their risk is increased, allowing them to make more informed decisions about their behaviours and treatment.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. paterson@ices.on.ca
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Llewellyn-Thomas
authors.forename: C David
authors.initials: CD
authors.lastname: Naylor
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003327:Coronary Disease / Q000453:epidemiology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010174:Pamphlets; D010358:Patient Participation; D010865:Pilot Projects; D018570:Risk Assessment / Q000379:methods*; D012647:Self-Assessment