Improving the management of people with a family history of breast cancer in primary care: before and after study of audit-based education
Identifieur interne : 003566 ( Main/Exploration ); précédent : 003565; suivant : 003567Improving the management of people with a family history of breast cancer in primary care: before and after study of audit-based education
Auteurs : Imran Rafi [Royaume-Uni] ; Susmita Chowdhury [Royaume-Uni] ; Tom Chan [Royaume-Uni] ; Ibrahim Jubber [Royaume-Uni] ; Mohammad Tahir [Royaume-Uni] ; Simon De Lusignan [Royaume-Uni]Source :
- BMC Family Practice [ 1471-2296 ] ; 2013.
Abstract
In England, guidance from National Institute for Clinical Excellence (NICE) states women with a family history of breast cancer presenting to primary care should be reassured or referred.
We reviewed the evidence for interventions that might be applied in primary care and conducted an audit of whether low risk women are correctly advised and flagged.
We conducted a literature review to identify modifiable risk factors. We extracted routinely collected data from the computerised medical record systems of 6 general practices (population approximately 30,000); of the variables identified in the guidance. We implemented a quality improvement (QI) intervention called audit-based education (ABE) comparing participant practices with guidelines and each other before and after; we report odds ratios (OR) of any change in data recording.
The review revealed evidence for advising on: diet, weight control, physical exercise, and alcohol. The proportion of patients with recordings of family history of: disease, neoplasms, and breast cancer were: 39.3%, 5.1% and 1.3% respectively. There was no significant change in the recording of family history of disease or cancer; OR 1.02 (95% CI 0.98-1.06); and 1.08 (95% CI 0.99-1.17) respectively. Recording of alcohol consumption and smoking both increased significantly; OR 1.36 (95% CI 1.30-1.43); and 1.42 (95% CI 1.27-1.60) respectively. Recording lifestyle advice fell; OR 0.84 (95% CI 0.81-0.88).
The study informs about current data recording and willingness to engage in ABE. Recording of risk factors improved after the intervention. Further QI is needed to achieve adherence to current guidance.
Url:
DOI: 10.1186/1471-2296-14-105
PubMed: 23879178
PubMed Central: 3734209
Affiliations:
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George’s, University of London, Cranmer Terrace, London SW17 0RE</wicri:regionArea><orgName type="university">Université de Londres</orgName><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Clinical Innovation and Research Centre (CIRC), Royal College of General Practitioners, 30 Euston Square, London NW1 2FB, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Clinical Innovation and Research Centre (CIRC), Royal College of General Practitioners, 30 Euston Square, London NW1 2FB</wicri:regionArea><wicri:noRegion>London NW1 2FB</wicri:noRegion></affiliation></author><author><name sortKey="Chowdhury, Susmita" sort="Chowdhury, Susmita" uniqKey="Chowdhury S" first="Susmita" last="Chowdhury">Susmita Chowdhury</name><affiliation wicri:level="1"><nlm:aff id="I3">PHG Foundation, 2 Worts Causeway, Cambridge, Cambridgeshire CB1 8RN, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>PHG Foundation, 2 Worts Causeway, Cambridge, Cambridgeshire CB1 8RN</wicri:regionArea><wicri:noRegion>Cambridgeshire CB1 8RN</wicri:noRegion></affiliation></author><author><name sortKey="Chan, Tom" sort="Chan, Tom" uniqKey="Chan T" first="Tom" last="Chan">Tom Chan</name><affiliation wicri:level="1"><nlm:aff id="I4">Department of Healthcare Management and Policy, University of Surrey, Guildford, Surrey GU2 7XH, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Healthcare Management and Policy, University of Surrey, Guildford, Surrey GU2 7XH</wicri:regionArea><wicri:noRegion>Surrey GU2 7XH</wicri:noRegion></affiliation></author><author><name sortKey="Jubber, Ibrahim" sort="Jubber, Ibrahim" uniqKey="Jubber I" first="Ibrahim" last="Jubber">Ibrahim Jubber</name><affiliation wicri:level="4"><nlm:aff id="I1">Division of Population Health Sciences and Education, St George’s, University of London, Cranmer Terrace, London SW17 0RE, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Division of Population Health Sciences and Education, St George’s, University of London, Cranmer Terrace, London SW17 0RE</wicri:regionArea><orgName type="university">Université de Londres</orgName><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Tahir, Mohammad" sort="Tahir, Mohammad" uniqKey="Tahir M" first="Mohammad" last="Tahir">Mohammad Tahir</name><affiliation wicri:level="1"><nlm:aff id="I4">Department of Healthcare Management and Policy, University of Surrey, Guildford, Surrey GU2 7XH, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Healthcare Management and Policy, University of Surrey, Guildford, Surrey GU2 7XH</wicri:regionArea><wicri:noRegion>Surrey GU2 7XH</wicri:noRegion></affiliation></author><author><name sortKey="De Lusignan, Simon" sort="De Lusignan, Simon" uniqKey="De Lusignan S" first="Simon" last="De Lusignan">Simon De Lusignan</name><affiliation wicri:level="1"><nlm:aff id="I4">Department of Healthcare Management and Policy, University of Surrey, Guildford, Surrey GU2 7XH, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Healthcare Management and Policy, University of Surrey, Guildford, Surrey GU2 7XH</wicri:regionArea><wicri:noRegion>Surrey GU2 7XH</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Family Practice</title><idno type="eISSN">1471-2296</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>In England, guidance from National Institute for Clinical Excellence (NICE) states women with a family history of breast cancer presenting to primary care should be reassured or referred.</p><p>We reviewed the evidence for interventions that might be applied in primary care and conducted an audit of whether low risk women are correctly advised and flagged.</p></sec><sec><title>Methods</title><p>We conducted a literature review to identify modifiable risk factors. We extracted routinely collected data from the computerised medical record systems of 6 general practices (population approximately 30,000); of the variables identified in the guidance. We implemented a quality improvement (QI) intervention called audit-based education (ABE) comparing participant practices with guidelines and each other before and after; we report odds ratios (OR) of any change in data recording.</p></sec><sec><title>Results</title><p>The review revealed evidence for advising on: diet, weight control, physical exercise, and alcohol. The proportion of patients with recordings of family history of: disease, neoplasms, and breast cancer were: 39.3%, 5.1% and 1.3% respectively. There was no significant change in the recording of family history of disease or cancer; OR 1.02 (95% CI 0.98-1.06); and 1.08 (95% CI 0.99-1.17) respectively. Recording of alcohol consumption and smoking both increased significantly; OR 1.36 (95% CI 1.30-1.43); and 1.42 (95% CI 1.27-1.60) respectively. Recording lifestyle advice fell; OR 0.84 (95% CI 0.81-0.88).</p></sec><sec><title>Conclusions</title><p>The study informs about current data recording and willingness to engage in ABE. Recording of risk factors improved after the intervention. 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Miedyzbrodzka</name></author><author><name sortKey="Clarke, A" uniqKey="Clarke A">A Clarke</name></author><author><name sortKey="Watson, Ms" uniqKey="Watson M">MS Watson</name></author><author><name sortKey="Douglas, A" uniqKey="Douglas A">A Douglas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Emery, J" uniqKey="Emery J">J Emery</name></author><author><name sortKey="Morris, H" uniqKey="Morris H">H Morris</name></author><author><name sortKey="Goodchild, R" uniqKey="Goodchild R">R Goodchild</name></author><author><name sortKey="Fanshawe, T" uniqKey="Fanshawe T">T Fanshawe</name></author><author><name sortKey="Prevost, At" uniqKey="Prevost A">AT Prevost</name></author><author><name sortKey="Bobrow, M" uniqKey="Bobrow M">M Bobrow</name></author><author><name sortKey="Kinmonth, Al" uniqKey="Kinmonth A">AL Kinmonth</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rubinstein, Ws" uniqKey="Rubinstein W">WS Rubinstein</name></author><author><name sortKey="Acheson, Ls" uniqKey="Acheson L">LS Acheson</name></author><author><name sortKey="O Eill, Sm" uniqKey="O Eill S">SM O’Neill</name></author><author><name sortKey="Ruffin, Mt" uniqKey="Ruffin M">MT Ruffin</name></author><author><name sortKey="Wang, C" uniqKey="Wang C">C Wang</name></author><author><name sortKey="Beaumont, Jl" uniqKey="Beaumont J">JL Beaumont</name></author><author><name sortKey="Rothrock, N" uniqKey="Rothrock N">N Rothrock</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li></region><settlement><li>Londres</li></settlement><orgName><li>Université de Londres</li></orgName></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Rafi, Imran" sort="Rafi, Imran" uniqKey="Rafi I" first="Imran" last="Rafi">Imran Rafi</name></region><name sortKey="Chan, Tom" sort="Chan, Tom" uniqKey="Chan T" first="Tom" last="Chan">Tom Chan</name><name sortKey="Chowdhury, Susmita" sort="Chowdhury, Susmita" uniqKey="Chowdhury S" first="Susmita" last="Chowdhury">Susmita Chowdhury</name><name sortKey="De Lusignan, Simon" sort="De Lusignan, Simon" uniqKey="De Lusignan S" first="Simon" last="De Lusignan">Simon De Lusignan</name><name sortKey="Jubber, Ibrahim" sort="Jubber, Ibrahim" uniqKey="Jubber I" first="Ibrahim" last="Jubber">Ibrahim Jubber</name><name sortKey="Rafi, Imran" sort="Rafi, Imran" uniqKey="Rafi I" first="Imran" last="Rafi">Imran Rafi</name><name sortKey="Tahir, Mohammad" sort="Tahir, Mohammad" uniqKey="Tahir M" first="Mohammad" last="Tahir">Mohammad Tahir</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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