Barriers to routine risk-score use for healthy primary care patients: survey and qualitative study

Risk scores for the primary prevention of chronic diseases in healthy adults are frequently recommended but often underused by general practitioners (GPs). The objectives of this study were to assess the use of and attitudes regarding the use of risk scores among GPs and to identify possible barriers to use.

Between November 7, 2007, and April 4, 2008, 68 GPs in Berlin, Germany, participated in the survey, and 24 were additionally invited to participate in focus groups. Quantitative data were analyzed descriptively and qualitative data were analyzed according to grounded theory.

Survey data of 42 GPs indicated that physicians regularly perform risk assessments for healthy patients, although most did not use risk scores. The usefulness of risk scores was rated largely positive. Focus groups revealed some confusion about the definition of risk scores and that participants resisted general use. Barriers to risk-score use were lack of lifestyle recommendations, regulatory constraints, the patient's role, and lack of accuracy. Suggestions for improvement included computerized risk prediction for multiple diseases simultaneously, better computer-generated visual presentation, and the integration of lifestyle recommendations.

The GPs perceive the routine use of risk scores as infeasible because of regulatory constraints and the nature of the physician-patient relationship. These factors need to be considered to increase risk-score use. Training of physicians could also help somewhat to overcome underuse. Use of computerized approaches that enable the prediction of risks for several chronic diseases simultaneously and improved computer-generated visual presentation may increase acceptance. Risk profiles should further be related to recommendations for health-behavior modification.