Health risk appraisal for older people in general practice using an expert system: a pilot study

Abstract

The prevention of disability in later life is a major challenge facing industrialised societies. Primary care practitioners are well positioned to maintain and promote health in older people, but the British experience of population-wide preventive interventions has been disappointing. Health risk appraisal (HRA), an emergent information-technology-based approach from the USA, has the potential for fulfilling some of the objectives of the National Service Framework for Older People. Information technology and expert systems allow the perspectives of older people on their health and health risk behaviours to be collated, analysed and converted into tailored health promotion advice without adding to the workload of primary care practitioners. The present paper describes a preliminary study of the portability of HRA to British settings. Cultural adaptation and feasibility testing of a comprehensive health risk assessment questionnaire was carried out in a single group practice with 12,500 patients, in which 58% of the registered population aged 65 years and over participated in the study. Eight out of 10 respondents at all ages found the questionnaire easy or very easy to understand and complete, although more than one-third had or would have liked assistance. More than half felt that the length of the questionnaire was about right, and one respondent in 10 disliked some questions. Of those who completed the questionnaire and received tailored, written health promotion advice, 39% provided feedback on this with comments that can be used for increasing the acceptability of tailored advice. These findings have informed a wider exploratory study in general practice.

Development, feasibility and performance of a health risk appraisal questionnaire for older persons

“…The majority of people judged the questionnaire as easy to comprehend (U.K., 81.4%; Germany, 93.1%; Switzerland, 97.2%) and to complete (83.2%, 91.4%, and 95.8%, respectively). Feed-back from older persons to the participant reports was systematically evaluated [9]. …”

Service use of older people who participate in primary care health promotion: a latent class analysis

“…We invited a random sample of 1 in 3 community-dwelling older people (≥65 years old) from five general practices in London and Hertfordshire to participate in the MRAO [12, 13] which was contextualised to each locality in 2012. The sampling strategy was based on a recruitment target of 150–200 per practice, equivalent to a 40% response rate.…”

Hausärztliche Prävention - Ein Vorschlag für eine Systematik

“…Man muss hier aber mit dem Nachteil unsystematischen Vorgehens, nämlich mit versäumter Einflussnahme, rechnen (denn nicht alle werden angesprochen) [23,28,29,32,37].…”