BACKGROUND The use of cardiovascular disease (CVD) prevention guidelines based on absolute risk assessment is poor around the world, including Australia. Behavioural barriers amongst GPs and patients include capability (e.g. difficulty communicating/understanding risk) and motivation (e.g. attitudes towards guidelines/medication). This paper outlines the theory-based development of a website for GP guidelines, and piloting of a new risk calculator/decision aid. METHODS Stage 1 involved identifying evidence-based solutions using the Behaviour Change Wheel (BCW) framework, informed by previous research involving 400 GPs and 600 patients/consumers. Stage 2 co-developed website content with GPs. Stage 3 piloted a prototype website at a national GP conference. Stage 4 iteratively improved the website based on "think aloud" interviews with GPs and patients. Stage 5 was a feasibility study to evaluate potential efficacy (guidelines-based recommendations for each risk category), acceptability (intended use) and demand (actual use over 1 month) amongst GPs (n = 98). RESULTS Stage 1 identified GPs as the target for behaviour change; the need for a new risk calculator/decision aid linked to existing audit and feedback training; and online guidelines as a delivery format. Stage 2-4 iteratively improved content and format based on qualitative feedback from GP and patient user testing over three rounds of website development. Stage 5 suggested potential efficacy with improved identification of hypothetical high risk patients (from 26 to 76%) and recommended medication (from 57 to 86%) after viewing the website (n = 42), but prescribing to low risk patients remained similar (from 19 to 22%; n = 37). Most GPs (89%) indicated they would use the website in the next month, and 72% reported using it again after one month (n = 98). Open feedback identified implementation barriers including a need for integration with medical software, low health literacy resources and pre-consultation assessment. CONCLUSIONS Following a theory-based development process and user co-design, the resulting intervention was acceptable to GPs with high intentions for use, improved identification of patient risk categories and more guidelines-based prescribing intentions for high risk but not low risk patients. The effectiveness of linking the intervention to clinical practice more closely to address implementation barriers will be evaluated in future research.

中文翻译：

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实施心血管疾病预防指南，将循证医学和共同决策转化为一般实践：基于理论的干预措施开发、定性试点和定量可行性。

背景技术基于绝对风险评估的心血管疾病（CVD）预防指南在世界各地（包括澳大利亚）的使用情况很差。全科医生和患者之间的行为障碍包括能力（例如沟通困难/理解风险）和动机（例如对指南/药物的态度）。本文概述了基于理论的全科医生指南网站的开发，以及新风险计算器/决策辅助的试点。方法 第一阶段涉及使用行为改变轮 (BCW) 框架确定基于证据的解决方案，该框架根据之前涉及 400 名全科医生和 600 名患者/消费者的研究提供信息。第二阶段与 GP 共同开发网站内容。第三阶段在全国 GP 会议上试用了一个原型网站。第四阶段基于对全科医生和患者的“大声思考”访谈，迭代改进了网站。第 5 阶段是一项可行性研究，旨在评估全科医生 (n = 98) 的潜在功效（针对每个风险类别的基于指南的建议）、可接受性（预期用途）和需求（超过 1 个月的实际使用）。结果 第一阶段将全科医生确定为行为改变的目标；需要与现有审计和反馈培训相关的新风险计算器/决策辅助工具；和在线指南作为交付格式。第 2-4 阶段根据全科医生的定性反馈和三轮网站开发的患者用户测试迭代改进内容和格式。第 5 阶段表明，在查看网站 (n = 42) 后，通过改进对假设的高风险患者（从 26% 到 76%）和推荐药物（从 57% 到 86%）的识别，具有潜在功效，但对低风险患者的处方仍然相似（从19% 至 22%；n = 37)。大多数全科医生 (89%) 表示他们将在下个月使用该网站，72% 的全科医生表示会在一个月后再次使用该网站 (n = 98)。公开反馈指出了实施障碍，包括需要与医疗软件集成、健康素养资源低和咨询前评估。结论 经过基于理论的开发过程和用户​​共同设计，最终的干预措施对于具有高使用意图的全科医生来说是可以接受的，改进了患者风险类别的识别，并且针对高风险而非低风险患者提供了更多基于指南的处方意图。将干预措施与临床实践更紧密地联系起来以解决实施障碍的有效性将在未来的研究中进行评估。