title: Factors influencing general practitioners' decisions about cardiovascular disease risk reassessment: findings from experimental and interview studies.
abstract: 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.
  
  
  
  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.
  
  
  
  
  
  
  
  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.
  
  
  
  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.
authors: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.|Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia.
authors: Shannon
authors: 0000-0001-6384-1745
authors: S
authors: McKinn
authors: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.|Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia.
authors: Carissa
authors: C
authors: Bonner
authors: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.|Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia.
authors: Jesse
authors: J
authors: Jansen
authors: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
authors: Armando
authors: A
authors: Teixeira-Pinto
authors: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.|Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia.
authors: Matthew
authors: M
authors: So
authors: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
authors: Les
authors: L
authors: Irwig
authors: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.|Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia.
authors: Jenny
authors: J
authors: Doust
authors: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.|Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia.
authors: Paul
authors: P
authors: Glasziou
authors: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. kirsten.mccaffery@sydney.edu.au.|Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia. kirsten.mccaffery@sydney.edu.au.
authors: Kirsten
authors: K
authors: McCaffery
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000517:prevention & control* / Q000523:psychology; D002784:Cholesterol / Q000097:blood; D000066491:Clinical Decision-Making; D005260:Female; D058006:General Practice; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009042:Motivation; D057240:Patient Preference; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D002784:Cholesterol
keywords: Cardiovascular disease; General practice; Prevention; Primary care; Risk assessment