title: Prompting Primary Care Providers about Increased Patient Risk As a Result of Family History: Does It Work?
abstract: BACKGROUND
  Electronic health records have the potential to facilitate family history use by primary care physicians (PCPs) to provide personalized care. The objective of this study was to determine whether automated, at-the-visit tailored prompts about family history risk change PCP behavior.
  
  
  METHODS
  Automated, tailored prompts highlighting familial risk for heart disease, stroke, diabetes, and breast, colorectal, or ovarian cancer were implemented during 2011 to 2012. Medical records of a cohort of community-based primary care patients, aged 35 to 65 years, who previously participated in our Family Healthware study and had a moderate or strong familial risk for any of the 6 diseases were subsequently reviewed. The main outcome measures were PCP response to the prompts, adding family history risk to problem summary lists, and patient screening status for each disease.
  
  
  RESULTS
  The 492 eligible patients had 847 visits during the study period; 152 visits had no documentation of response to a family history prompt. Of the remaining 695 visits, physician responses were reviewed family history (n = 372, 53.5%), discussed family history (n = 159, 22.9%), not addressed (n = 155, 22.3%), and reviewed family history and ordered tests/referrals (n = 5, 0.7%). There was no significant change in problem summary list documentation of risk status or screening interventions for any of the 6 diseases.
  
  
  CONCLUSIONS
  No change occurred upon instituting simple, at-the-visit family history prompts geared to improve PCPs' ability to identify patients at high risk for 6 common conditions. The results are both surprising and disappointing. Further studies should examine physicians' perception of the utility of prompts for family history risk.
authors.affiliation: From the Department of Family Medicine (PZ, MAP, MTR), the Division of Molecular Medicine and Genetics, Department of Internal Medicine (WRU), and the Department of Human Genetics (WRU), University of Michigan, Ann Arbor. pzaz@umich.edu.
authors.forename: Philip
authors.initials: P
authors.lastname: Zazove
authors.affiliation: From the Department of Family Medicine (PZ, MAP, MTR), the Division of Molecular Medicine and Genetics, Department of Internal Medicine (WRU), and the Department of Human Genetics (WRU), University of Michigan, Ann Arbor.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Plegue
authors.affiliation: From the Department of Family Medicine (PZ, MAP, MTR), the Division of Molecular Medicine and Genetics, Department of Internal Medicine (WRU), and the Department of Human Genetics (WRU), University of Michigan, Ann Arbor.
authors.forename: Wendy R
authors.initials: WR
authors.lastname: Uhlmann
authors.affiliation: From the Department of Family Medicine (PZ, MAP, MTR), the Division of Molecular Medicine and Genetics, Department of Internal Medicine (WRU), and the Department of Human Genetics (WRU), University of Michigan, Ann Arbor.
authors.forename: Mack T
authors.initials: MT
authors.lastname: Ruffin
mesh_terms: D000328:Adult; D000368:Aged; D057286:Electronic Health Records; D005260:Female; D020022:Genetic Predisposition to Disease; D040941:Heredity; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D017010:Reminder Systems; D018570:Risk Assessment; D012307:Risk Factors
keywords: Genetics; Primary Health Care; Reminder Systems