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Abstract：
The use of cardiovascular disease (CVD) prevention guidelines based on absolute risk assessment is poor around the world, including Australia. Behavioural barriers amongst GPs and patients include capability (e.g. difficulty communicating/understanding risk) and motivation (e.g. attitudes towards guidelines/medication). This paper outlines the theory-based development of a website for GP guidelines, and piloting of a new risk calculator/decision aid.
Stage 1 involved identifying evidence-based solutions using the Behaviour Change Wheel (BCW) framework, informed by previous research involving 400 GPs and 600 patients/consumers. Stage 2 co-developed website content with GPs. Stage 3 piloted a prototype website at a national GP conference. Stage 4 iteratively improved the website based on \"think aloud\" interviews with GPs and patients. Stage 5 was a feasibility study to evaluate potential efficacy (guidelines-based recommendations for each risk category), acceptability (intended use) and demand (actual use over 1 month) amongst GPs (n = 98).
Stage 1 identified GPs as the target for behaviour change; the need for a new risk calculator/decision aid linked to existing audit and feedback training; and online guidelines as a delivery format. Stage 2-4 iteratively improved content and format based on qualitative feedback from GP and patient user testing over three rounds of website development. Stage 5 suggested potential efficacy with improved identification of hypothetical high risk patients (from 26 to 76%) and recommended medication (from 57 to 86%) after viewing the website (n = 42), but prescribing to low risk patients remained similar (from 19 to 22%; n = 37). Most GPs (89%) indicated they would use the website in the next month, and 72% reported using it again after one month (n = 98). Open feedback identified implementation barriers including a need for integration with medical software, low health literacy resources and pre-consultation assessment.
Following a theory-based development process and user co-design, the resulting intervention was acceptable to GPs with high intentions for use, improved identification of patient risk categories and more guidelines-based prescribing intentions for high risk but not low risk patients. The effectiveness of linking the intervention to clinical practice more closely to address implementation barriers will be evaluated in future research.
Stage 1 involved identifying evidence-based solutions using the Behaviour Change Wheel (BCW) framework, informed by previous research involving 400 GPs and 600 patients/consumers. Stage 2 co-developed website content with GPs. Stage 3 piloted a prototype website at a national GP conference. Stage 4 iteratively improved the website based on \"think aloud\" interviews with GPs and patients. Stage 5 was a feasibility study to evaluate potential efficacy (guidelines-based recommendations for each risk category), acceptability (intended use) and demand (actual use over 1 month) amongst GPs (n = 98).
Stage 1 identified GPs as the target for behaviour change; the need for a new risk calculator/decision aid linked to existing audit and feedback training; and online guidelines as a delivery format. Stage 2-4 iteratively improved content and format based on qualitative feedback from GP and patient user testing over three rounds of website development. Stage 5 suggested potential efficacy with improved identification of hypothetical high risk patients (from 26 to 76%) and recommended medication (from 57 to 86%) after viewing the website (n = 42), but prescribing to low risk patients remained similar (from 19 to 22%; n = 37). Most GPs (89%) indicated they would use the website in the next month, and 72% reported using it again after one month (n = 98). Open feedback identified implementation barriers including a need for integration with medical software, low health literacy resources and pre-consultation assessment.
Following a theory-based development process and user co-design, the resulting intervention was acceptable to GPs with high intentions for use, improved identification of patient risk categories and more guidelines-based prescribing intentions for high risk but not low risk patients. The effectiveness of linking the intervention to clinical practice more closely to address implementation barriers will be evaluated in future research.
摘要：
在全球范围内，基于绝对风险评估的心血管疾病（CVD）预防指南的使用很差，包括澳大利亚。全科医生和患者之间的行为障碍包括能力(例如难以沟通/理解风险)和动机(例如对指南/药物的态度)。本文概述了基于理论的GP指南网站的开发，并试行新的风险计算器/决策辅助工具。
阶段1涉及使用行为变化轮（BCW）框架确定基于证据的解决方案，以前的研究涉及400名全科医生和600名患者/消费者。第二阶段与GP共同开发网站内容。第三阶段在全国GP会议上试用了原型网站。第4阶段基于对全科医生和患者的“大声思考”访谈，对网站进行了迭代改进。第5阶段是评估潜在疗效的可行性研究（每个风险类别的基于指南的建议），全科医生(n=98)的可接受性(预期用途)和需求(实际使用超过1个月)。
阶段1将GP确定为行为改变的目标；需要与现有审计和反馈培训相关的新风险计算器/决策辅助；以及作为交付格式的在线指南。阶段2-4在三轮网站开发中，基于来自GP和患者用户测试的定性反馈，迭代地改进了内容和格式。第5阶段显示潜在的疗效，在查看网站（n=42）后，可以更好地识别假设的高风险患者（从26％到76％）和推荐的药物（从57％到86％），但对低风险患者的处方仍然相似(从19%到22%;n=37).大多数全科医生（89％）表示他们将在下个月使用该网站，72%报告在一个月后再次使用它（n=98）。公开反馈确定了实施障碍，包括需要与医疗软件集成，低健康素养资源和咨询前评估。
遵循基于理论的开发过程和用户共同设计，由此产生的干预措施对于具有高使用意向的全科医生来说是可以接受的，改善了对患者风险类别的识别，并为高风险但非低风险患者提供了更多基于指南的处方意向。将干预措施与临床实践更紧密地联系起来以解决实施障碍的有效性将在未来的研究中进行评估。
阶段1涉及使用行为变化轮（BCW）框架确定基于证据的解决方案，以前的研究涉及400名全科医生和600名患者/消费者。第二阶段与GP共同开发网站内容。第三阶段在全国GP会议上试用了原型网站。第4阶段基于对全科医生和患者的“大声思考”访谈，对网站进行了迭代改进。第5阶段是评估潜在疗效的可行性研究（每个风险类别的基于指南的建议），全科医生(n=98)的可接受性(预期用途)和需求(实际使用超过1个月)。
阶段1将GP确定为行为改变的目标；需要与现有审计和反馈培训相关的新风险计算器/决策辅助；以及作为交付格式的在线指南。阶段2-4在三轮网站开发中，基于来自GP和患者用户测试的定性反馈，迭代地改进了内容和格式。第5阶段显示潜在的疗效，在查看网站（n=42）后，可以更好地识别假设的高风险患者（从26％到76％）和推荐的药物（从57％到86％），但对低风险患者的处方仍然相似(从19%到22%;n=37).大多数全科医生（89％）表示他们将在下个月使用该网站，72%报告在一个月后再次使用它（n=98）。公开反馈确定了实施障碍，包括需要与医疗软件集成，低健康素养资源和咨询前评估。
遵循基于理论的开发过程和用户共同设计，由此产生的干预措施对于具有高使用意向的全科医生来说是可以接受的，改善了对患者风险类别的识别，并为高风险但非低风险患者提供了更多基于指南的处方意向。将干预措施与临床实践更紧密地联系起来以解决实施障碍的有效性将在未来的研究中进行评估。
