Comparison of estimates and calculations of risk of coronary heart disease by doctors and nurses using different calculation tools in general practice: cross sectional study

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@article{755bff00c116404d8735d955934aaa4d,
title = "Comparison of estimates and calculations of risk of coronary heart disease by doctors and nurses using different calculation tools in general practice: cross sectional study",
abstract = "Objective To assess the effect of using different risk calculation tools on how general practitioners and practice nurses evaluate the risk of coronary heart disease with clinical data routinely available in patients' records. Design Subjective estimates of the risk of coronary, heart disease and results of four different methods of calculation of risk were compared with each other and a reference standard that bad been calculated with the Framingham equation: calculations were based on a sample of patients' records, randomly selected from groups at risk of coronary heart disease. Setting General practices in central England. Participants 18 general practitioner's and 18 practice nurses. Main outcome measures Agreement off results of risk estimation and risk calculation with reference calculation: agreement of general practitioners with practice nurses; sensitivity and specificity of the different methods of risk calculation to detect patients at high or low risk of coronary heart disease. Results Only a minority of patients' records contained all of the risk factors required lot the formal calculation of the risk of coronary heart disease (concentrations of high density lipoprotein (HDL) cholesterol were present in only 21%), Agreement of risk calculations with the reference standard was moderate (kappa = 0.33-0.65 for practice nurses and 0.33 to 0.65 for general practitioners. depending on calculation tool), showing a trend for underestimation of risk. Moderate agreement was seen between the risks calculated by general practitioners and practice nurses for the same patients (kappa = 0.47 to 0.58). The British charts gave the most sensitive results for risk of coronary heart disease (practice nurses 79% general practitioners 80%), and it also gave the most specific results for practice nurses (100%), whereas the Sheffield table was the most specific method for general practitioners Conclusions Routine calculation of the risk of coronary heart disease in primary care is hampered by poor availability, of data on risk factors. General practitioners and practice nurse; are able to evaluate the risk of coronary heart disease with only moderate accuracy. Data about risk factors need to be collected systematically. to allow the use of the most appropriate calculation tools.",
author = "Richard McManus and Jonathan Mant and CFM Meulendijks and Rosaleen Salter and Helen Pattison and Andrea Roalfe and Frederick Hobbs",
year = "2002",
month = feb,
day = "23",
doi = "10.1136/bmj.324.7335.459",
language = "English",
volume = "324",
pages = "459--464",
journal = "British Medical Journal",
issn = "0959-8138",
publisher = "BMJ Publishing Group",
number = "7335",

}

RIS

TY - JOUR

T1 - Comparison of estimates and calculations of risk of coronary heart disease by doctors and nurses using different calculation tools in general practice: cross sectional study

AU - McManus, Richard

AU - Mant, Jonathan

AU - Meulendijks, CFM

AU - Salter, Rosaleen

AU - Pattison, Helen

AU - Roalfe, Andrea

AU - Hobbs, Frederick

PY - 2002/2/23

Y1 - 2002/2/23

N2 - Objective To assess the effect of using different risk calculation tools on how general practitioners and practice nurses evaluate the risk of coronary heart disease with clinical data routinely available in patients' records. Design Subjective estimates of the risk of coronary, heart disease and results of four different methods of calculation of risk were compared with each other and a reference standard that bad been calculated with the Framingham equation: calculations were based on a sample of patients' records, randomly selected from groups at risk of coronary heart disease. Setting General practices in central England. Participants 18 general practitioner's and 18 practice nurses. Main outcome measures Agreement off results of risk estimation and risk calculation with reference calculation: agreement of general practitioners with practice nurses; sensitivity and specificity of the different methods of risk calculation to detect patients at high or low risk of coronary heart disease. Results Only a minority of patients' records contained all of the risk factors required lot the formal calculation of the risk of coronary heart disease (concentrations of high density lipoprotein (HDL) cholesterol were present in only 21%), Agreement of risk calculations with the reference standard was moderate (kappa = 0.33-0.65 for practice nurses and 0.33 to 0.65 for general practitioners. depending on calculation tool), showing a trend for underestimation of risk. Moderate agreement was seen between the risks calculated by general practitioners and practice nurses for the same patients (kappa = 0.47 to 0.58). The British charts gave the most sensitive results for risk of coronary heart disease (practice nurses 79% general practitioners 80%), and it also gave the most specific results for practice nurses (100%), whereas the Sheffield table was the most specific method for general practitioners Conclusions Routine calculation of the risk of coronary heart disease in primary care is hampered by poor availability, of data on risk factors. General practitioners and practice nurse; are able to evaluate the risk of coronary heart disease with only moderate accuracy. Data about risk factors need to be collected systematically. to allow the use of the most appropriate calculation tools.

AB - Objective To assess the effect of using different risk calculation tools on how general practitioners and practice nurses evaluate the risk of coronary heart disease with clinical data routinely available in patients' records. Design Subjective estimates of the risk of coronary, heart disease and results of four different methods of calculation of risk were compared with each other and a reference standard that bad been calculated with the Framingham equation: calculations were based on a sample of patients' records, randomly selected from groups at risk of coronary heart disease. Setting General practices in central England. Participants 18 general practitioner's and 18 practice nurses. Main outcome measures Agreement off results of risk estimation and risk calculation with reference calculation: agreement of general practitioners with practice nurses; sensitivity and specificity of the different methods of risk calculation to detect patients at high or low risk of coronary heart disease. Results Only a minority of patients' records contained all of the risk factors required lot the formal calculation of the risk of coronary heart disease (concentrations of high density lipoprotein (HDL) cholesterol were present in only 21%), Agreement of risk calculations with the reference standard was moderate (kappa = 0.33-0.65 for practice nurses and 0.33 to 0.65 for general practitioners. depending on calculation tool), showing a trend for underestimation of risk. Moderate agreement was seen between the risks calculated by general practitioners and practice nurses for the same patients (kappa = 0.47 to 0.58). The British charts gave the most sensitive results for risk of coronary heart disease (practice nurses 79% general practitioners 80%), and it also gave the most specific results for practice nurses (100%), whereas the Sheffield table was the most specific method for general practitioners Conclusions Routine calculation of the risk of coronary heart disease in primary care is hampered by poor availability, of data on risk factors. General practitioners and practice nurse; are able to evaluate the risk of coronary heart disease with only moderate accuracy. Data about risk factors need to be collected systematically. to allow the use of the most appropriate calculation tools.

UR - http://www.scopus.com/inward/record.url?scp=0037160709&partnerID=8YFLogxK

U2 - 10.1136/bmj.324.7335.459

DO - 10.1136/bmj.324.7335.459

M3 - Article

C2 - 11859049

VL - 324

SP - 459

EP - 464

JO - British Medical Journal

JF - British Medical Journal

SN - 0959-8138

IS - 7335

ER -