Use of global coronary heart disease risk assessment in practice: a cross-sectional survey of a sample of U.S. physicians

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  • Shillinglaw, Benjamin
    • Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
    • Other Affiliation: Department of Medicine, University of Colorado Denver School of Medicine, Denver, Colorado, USA
  • Viera, Anthony
    • Affiliation: School of Medicine, Department of Family Medicine
  • Edwards, Teresa
    • Affiliation: Odum Institute for Research in Social Science
    • Other Affiliation: Department of Medicine, University of Colorado Denver School of Medicine, Denver, Colorado, USA
  • Simpson, Ross, Jr.
    • Affiliation: School of Medicine, Department of Medicine
  • Sheridan, Stacey
    • Affiliation: School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology
Abstract
  • Abstract Background Global coronary heart disease (CHD) risk assessment is recommended to guide primary preventive pharmacotherapy. However, little is known about physicians' understanding and use of global CHD risk assessment. Our objective was to examine US physicians' awareness, use, and attitudes regarding global CHD risk assessment in clinical practice, and how these vary by provider specialty. Methods Using a web-based survey of US family physicians, general internists, and cardiologists, we examined awareness of tools available to calculate CHD risk, method and use of CHD risk assessment, attitudes towards CHD risk assessment, and frequency of using CHD risk assessment to guide recommendations of aspirin, lipid-lowering and blood pressure (BP) lowering therapies for primary prevention. Characteristics of physicians indicating they use CHD risk assessments were compared in unadjusted and adjusted analyses. Results A total of 952 physicians completed the questionnaire, with 92% reporting awareness of tools available to calculate CHD global risk. Among those aware of such tools, over 80% agreed that CHD risk calculation is useful, improves patient care, and leads to better decisions about recommending preventive therapies. However, only 41% use CHD risk assessment in practice. The most commonly reported barrier to CHD risk assessment is that it is too time consuming. Among respondents who calculate global CHD risk, 69% indicated they use it to guide lipid lowering therapy recommendations; 54% use it to guide aspirin therapy recommendations; and 48% use it to guide BP lowering therapy. Only 40% of respondents who use global CHD risk routinely tell patients their risk. Use of a personal digital assistant or smart phone was associated with reported use of CHD risk assessment (adjusted OR 1.58; 95% CI 1.17-2.12). Conclusions Reported awareness of tools to calculate global CHD risk appears high, but the majority of physicians in this sample do not use CHD risk assessments in practice. A minority of physicians in this sample use global CHD risk to guide prescription decisions or to motivate patients. Educational interventions and system improvements to improve physicians' effective use of global CHD risk assessment should be developed and tested.
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  • Article
Rights statement
  • In Copyright
Rights holder
  • Benjamin Shillinglaw et al.; licensee BioMed Central Ltd.
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Journal title
  • BMC Health Services Research
Journal volume
  • 12
Journal issue
  • 1
Page start
  • 20
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1472-6963
Bibliographic citation
  • BMC Health Services Research. 2012 Jan 24;12(1):20
Publisher
  • BioMed Central Ltd
Access right
  • Open Access
Date uploaded
  • August 23, 2012

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file details 1472-6963-12-20.pdf 2019-05-06 Public Download
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file details Geographic regions of respondents vs nonrespondents. The table shows that the geographic regions between respondents and nonrespondents were similar. 2019-05-06 Public Download