title: Assessing family history of chronic disease in primary care: Prevalence, documentation, and appropriate screening.
abstract: OBJECTIVE
  To assess the proportion of primary care patients who report a family history (FH) of type 2 diabetes, coronary artery disease, breast cancer, or colorectal cancer (CRC); assess concordance of FH information derived from the electronic medical record (EMR) compared with patient-completed health questionnaires; and assess whether appropriate screening was informed by risk based solely on FH.
  
  
  METHODS
  Data from the BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) trial were used. Patients were mailed questionnaires. Baseline FH and screening data were obtained for enrolled patients from the EMR and health questionnaires.
  
  
  METHODS
  Ontario and Alberta.
  
  
  METHODS
  Randomly selected patients from 8 family practices.
  
  
  METHODS
  Agreement on FH between the EMR and questionnaire was determined; logistic regression was used to assess significant predictors of screening.
  
  
  RESULTS
  In total, 775 of 789 (98%) patients completed the health questionnaire. The mean age of participants was 52.5 years and 72% were female. A minimum of 12% of patients (range 12% to 36%) had a reported FH of 1 of 4 chronic diseases. Among patients with positive FH, the following proportions of patients had that FH recorded in the EMR compared with the questionnaire: diabetes, 24% in the EMR versus 36% on the questionnaire, κ = 0.466; coronary artery disease, 35% in the EMR versus 22% on the questionnaire, κ = 0.225; breast cancer, 21% in the EMR versus 22% on the questionnaire, κ = 0.241; and CRC, 12% in the EMR versus 14% on the questionnaire, κ = 0.510. There was moderate agreement for diabetes and CRC. The presence of FH was a significant predictor of CRC screening (odds ratio 1.9, 95% CI 1.1 to 3.1).
  
  
  CONCLUSIONS
  A moderate prevalence of FH was found for 4 conditions for which screening recommendations vary with risk based on FH. Having patients self-complete an FH was thought to be feasible; however, questions about FH accuracy and completeness from both self-report and EMR remain. Work is needed to determine how to facilitate the adoption of FH tools into practice as well as strategies linking familial risk to appropriate screening.Trial registration number ISRCTN07170460 (ISRCTN Registry).
authors.affiliation: Professor and Sydney G. Frankfort Chair in the Department of Family and Community Medicine of the Sinai Health System at the University of Toronto in Ontario. june.carroll@sinaihealthsystem.ca.
authors.forename: June C
authors.initials: JC
authors.lastname: Carroll
authors.affiliation: Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
authors.forename: Denise
authors.initials: D
authors.lastname: Campbell-Scherer
authors.affiliation: Research associate in the Ray D. Wolfe Department of Family Medicine in the Sinai Health System.
authors.forename: Joanne A
authors.initials: JA
authors.lastname: Permaul
authors.affiliation: Second-year family medicine resident at Women's College Hospital at the University of Toronto.
authors.forename: Jesse
authors.initials: J
authors.lastname: Myers
authors.affiliation: Director of Research in the Department of Family Medicine Research Program at the University of Alberta.
authors.forename: Donna P
authors.initials: DP
authors.lastname: Manca
authors.affiliation: Biostatistician in the Department of Family and Community Medicine at the University of Toronto.
authors.forename: Christopher
authors.initials: C
authors.lastname: Meaney
authors.affiliation: Biostatistician in the Department of Family and Community Medicine at the University of Toronto.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: Giblon Professor and Vice Chair of Research in the Department of Family and Community Medicine at the University of Toronto and Director of Knowledge Translation Research in the Health Services Research Program at the Ontario Institute for Cancer Research.
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
mesh_terms: D000368:Aged; D000416:Alberta; D002908:Chronic Disease / Q000145:classification / Q000453:epidemiology*; D004282:Documentation / Q000592:standards*; D057286:Electronic Health Records / Q000592:standards*; D005192:Family Health / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009864:Ontario; D011320:Primary Health Care / Q000458:organization & administration*; D057566:Self Report