Implementation of a primary-tertiary shared care model to improve the detection of familial hypercholesterolaemia (FH): a mixed methods pre-post implementation study protocol

Abstract

Introduction: Familial hypercholesterolaemia (FH) is an autosomal dominant inherited disorder of lipid metabolism and a preventable cause of premature cardiovascular disease. Current detection rates for this highly treatable condition are low. Early detection and management of FH can significantly reduce cardiac morbidity and mortality. This study aims to implement a primary-tertiary shared care model to improve detection rates for FH. The primary objective is to evaluate the implementation of a shared care model and support package for genetic testing of FH. This protocol describes the design and methods used to evaluate the implementation of the shared care model and support package to improve the detection of FH.

Methods and analysis: This mixed methods pre-post implementation study design will be used to evaluate increased detection rates for FH in the tertiary and primary care setting. The primary-tertiary shared care model will be implemented at NSW Health Pathology and Sydney Local Health District in NSW, Australia, over a 12-month period. Implementation of the shared care model will be evaluated using a modification of the implementation outcome taxonomy and will focus on the acceptability, evidence of delivery, appropriateness, feasibility, fidelity, implementation cost and timely initiation of the intervention. Quantitative pre-post and qualitative semistructured interview data will be collected. It is anticipated that data relating to at least 62 index patients will be collected over this period and a similar number obtained for the historical group for the quantitative data. We anticipate conducting approximately 20 interviews for the qualitative data.

Ethics and dissemination: Ethical approval has been granted by the ethics review committee (Royal Prince Alfred Hospital Zone) of the Sydney Local Health District (Protocol ID: X23-0239). Findings will be disseminated through peer-reviewed publications, conference presentations and an end-of-study research report to stakeholders.

Keywords: cardiovascular disease; genetics; implementation science; patient-centered care; primary care.

Figure 1

Study protocol flow diagram for evaluating the implementation of the primary-tertiary shared care model. *Cardiologists, geneticists, pathologists and paediatricians. FH, familial hypercholesterolaemia; GP, general practitioner; REDCap, Research Electronic Data Capture; RPAH, Royal Prince Alfred Hospital.

Figure 2

FH intervention for the primary-tertiary shared care model. *Refers to Royal Prince Alfred Hospital Vascular Health Clinic. ¥Includes one-page cascade screening guide for GP, prefilled pathology form, genetic testing consent form, patient FH fact sheet and FH-specific resources for primary care. ǂFor positive results, the package includes results letter for GP, results letter for patient, family letter and FH registry consent form. §The National FH Registry is an electronic database where patients can provide consent for their medical information, family history and other related information to be collected for research purposes. EOI, expression of interest; FH, familial hypercholesterolaemia; GP, general practitioner; REDCap, Research Electronic Data Capture.