Holt et al present interesting data on the effect of automated electronic prompts on primary prevention of cardiovascular disease.1
Their results support recent anecdotal observations I made while trying to achieve the yearly cardiovascular disease (CVD)/cornary heart disease (CHD) QOF targets for one of the local practices in Fulham.
It is interesting to see these observations corroborated by a well conducted randomised controlled trial.
In contrast to the EMIS software used in their study, our practice uses VISION software that has a built in CVD/CHD risk calculator based on the Framingham risk equation applied to the most recent risk factor measurements.
Each patient's CVD/CHD risk is immediately visible in the lower left-hand corner of the computer screen. Clicking on the reported risk score releases a pop-up window containing the risk calculator and recent measurements of risk factors such as smoking, cholesterol, and blood pressure, presenting the opportunity to address unmet QOF targets and control clinical parameters.
Translating identified risk and appropriate interventions into improved clinical outcomes is the bigger challenge, and one clear potential implication from Holt et al's study is that high QOF CVD/CHD scores may not necessarily result in reduction in cardiovascular event rates.
The reasons for this are not clear and are probably multifactorial, however, poor patient understanding of CVD/CHD risk and risk reduction is contributory and can be partly addressed by using the CVD/CHD risk calculator interactively during consultations.
This can be done by demonstrating to the patient how his or her risk can increase or decrease with positive or negative changes in the measurements of clinical parameters. Therefore, the CVD/CHD risk calculator can also be a powerful tool used to build therapeutic relationships and improve understanding of CVD/CHD risk and what it means for each patient on a personal level.
- © British Journal of General Practice, 2010.
