An Innovative Strategy for Collecting Family Health History: An Effectiveness-Implementation Trial in Primary Care Clinics.

Abstract

We aimed to evaluate an innovative strategy to collect family history (FH) and explore patients' views of this strategy. We conducted a matched-pair effectiveness-implementation trial in family practices affiliated with the University of Toronto Practice-Based Research Network (UTOPIAN). The intervention group included family physicians (FPs) from randomly selected practices using electronic health records (EHRs) and an e-mailing platform, and randomly selected patients aged 30-69 years (4/FP/week) seen in clinic over a 6-month period. The matched control group included FPs (1:1) and patients (up to 5:1) from the UTOPIAN database. The intervention included patient and FP education, an e-mailed patient invitation to complete an FH questionnaire, automatic FH EHR upload, FP notification of completed FH questionnaire, and links to clinical support tools. Intervention patients were e-mailed a postvisit follow-up questionnaire. The assessed outcome was new documentation of FH in the EHR using mixed effects logistic regression and descriptive statistics for patient feedback. Fifteen FPs and 576 patients were recruited from 3 multidisciplinary team practices to the intervention group, matched to 15 FPs and 2,203 patients in the control group. Within 30 days of visit, a new FH was documented in the EHR for 93/576 (16.1%) of intervention patients compared with 5/2,203 (0.2%) control patients (adjusted OR = 94.2; 95% CI, 36.8-240.8). New cancer FH documentation was greater in the intervention group compared with the control group (7.8% vs 0.1%; <i>P</i> < .01). Of patients who reported discussing FH (n = 296), 24.5% reported screening test recommended, 7.5% referral to a nongenetics specialist, and 2.4% referral to a genetics specialist. Most patients (60.5%) found this FH strategy helpful. This study showed improved collection/documentation of FH. Contributors to success of the intervention included being patient completed and seamless EHR integration with a reminder. This FH strategy needs tailoring to different contexts.