Prompting primary care providers about increased patient risk as a result of family history: Does It work?

Background: electronic health records have the potential to facilitate family history use by primary care physicians (pcps) to provide personalized care. the objective of this study was to determine whether automated,at-the-visit tailored prompts about family history risk change pcp behavior. methods: automated,tailored prompts highlighting familial risk for heart disease,stroke,diabetes,and breast,colorectal,or ovarian cancer were implemented during 2011 to 2012. medical records of a cohort of community-based primary care patients,aged 35 to 65 years,who previously participated in our family healthware study and had a moderate or strong familial risk for any of the 6 diseases were subsequently reviewed. the main outcome measures were pcp response to the prompts,adding family history risk to problem summary lists,and patient screening status for each disease. results: the 492 eligible patients had 847 visits during the study period; 152 visits had no documentation of response to a family history prompt. of the remaining 695 visits,physician responses were reviewed family history (n = 372,53.5%),discussed family history (n = 159,22.9%),not addressed (n = 155,22.3%),and reviewed family history and ordered tests/referrals (n = 5,0.7%). there was no significant change in problem summary list documentation of risk status or screening interventions for any of the 6 diseases. conclusions: no change occurred upon instituting simple,at-the-visit family history prompts geared to improve pcps' ability to identify patients at high risk for 6 common conditions. the results are both surprising and disappointing. further studies should examine physicians' perception of the utility of prompts for family history risk. © 2015,american board of family medicine. all rights reserved.