Impact on clinical practice of the Joint British Societies' cardiovascular risk assessment tools

Objectives: The aim of this study was to evaluate the Joint British Societies' (JBS 2) Factfile, cardiovascular risk assessment paper charts and electronic risk calculator posted to health professionals in general practice. Design: Phase one: surveys on use of the JBS 2 charts and calculator; views on improving use and acceptability. Phase two: six focus groups and two semi-structured interviews on use of the JBS 2 charts and calculator; views on expression of risk, communication of risk and risk management. Participants: Phase one: general practitioners (GPs) and practice nurses. Phase two: GPs, practice nurses and nurse practitioners recruited via the survey; eligible patients invited by GPs. Setting: Primary care. Results: A high response rate (81.3%, 825/1015) was obtained to a national on-line survey of GPs using Pearl Medical Blackberries®. The JBS 2 charts were used by around 1 in 5 GPs and the electronic risk calculator by around 1 in 6. Patients and health professionals found the concept of risk difficult, preferred relative to absolute risk and liked the JBS 2 electronic risk thermometer and its ability to illustrate how changes in risk factors affect risk levels. Communication of risk in visual terms was a key to understanding the concept. The most important factor was risk management; how to motivate and support patients to maintain healthy lifestyles and concordance with medication was as important as communication of risk. Health professionals need training in both aspects. Conclusions: To maximise the use of cardiovascular risk assessment tools, multiple approaches are needed; it is not sufficient to distribute them in the post. Communicating and managing cardiovascular risk is difficult; to be effective more time is needed than is available in a routine GP appointment. Practice nurses may be well suited for this role. Costs of training and continuing support need to be built into the overall costs of the national programme for cardiovascular screening now known as NHS Health Checks.