Primary care practice adherence to National Cholesterol Education Program guidelines for patients with coronary heart disease
Primary care practice adherence to National Cholesterol Education Program guidelines for patients with coronary heart disease
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DOI：
10.1001/archinte.158.11.1238
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发表时间：
1998-06-08
影响因子：
--
通讯作者：
Brown, RL
中科院分区：
文献类型：
--
作者：
McBride, P;Schrott, HG;Brown, RL
背景：临床试验表明，胆固醇管理对心血管疾病（CVD）患者有显著益处。1993年出版并广泛散发了建议筛查和治疗目标的国家准则。本研究探讨胆固醇筛查和管理的初级保健医生后，guidelines were released.Methods：医疗记录和患者调查提供了603例心血管疾病患者的数据，年龄在27至70岁，从45个国家的做法在1993年至1995年。医生调查测量了估计的性能和其他变量。医生和患者的因素与遵守，或缺乏遵守，以国家的指南进行了检查，使用单变量和多变量analysis.Results：共199例（33%）与心血管疾病没有筛选与血脂面板，271例（45%）没有接受饮食咨询，404（67%）没有接受胆固醇药物治疗。只有84名CVD患者（14%）达到推荐的低密度脂蛋白水平低于2.58 mmol/L（100 mg/dL），302名（50%）甘油三酯水平低于2.26 mmol/L（200 mg/dL）。有血运重建史和低密度脂蛋白和/或甘油三酯水平较高的患者更有可能接受治疗，但其他患者因素，包括CVD风险因素，并不能预测治疗。医生的专业是不相关的治疗差异，但医生在实践中为更少的几年订购更多的血脂panels.Conclusions：大多数心血管疾病患者在初级保健没有接受胆固醇筛查和管理建议的国家胆固醇教育计划指南在2年后，他们的释放。增加胆固醇筛查和治疗应该是提高实践质量的优先事项，并可能导致高危患者CVD事件的显着减少。
Background: Clinical trials demonstrate significant benefit from cholesterol management for patients with cardiovascular disease (CVD). National guidelines recommending goals for screening and treatment were published in 1993 and widely disseminated. This study examines cholesterol screening and management by primary care physicians after the guidelines were released.Methods: Medical records and patient surveys provided data for 603 patients with CVD, aged 27 to 70 years, from 45 practices in 4 states during 1993 to 1995. Physician surveys measured estimated performance and other variables. Physician and patient factors associated with adherence, or lack of adherence, to national guidelines were examined using univariate and multivariate analyses.Results: A total of 199 patients (33%) with CVD were not screened with lipid panels, 271 patients (45%) were not receiving dietary counseling, and 404 (67%) were not receiving cholesterol medication. Only 84 patients (14%) with CVD had achieved the recommended low-density lipoprotein level of less than 2.58 mmol/L (100 mg/dL) and 302 (50%) had triglyceride levels lower than 2.26 mmol/L (200 mg/dL). Patients with a revascularization history and higher low-density lipoprotein and/or triglyceride levels were more likely to receive treatment, but other patient factors, including CVD risk factors, did not predict treatment. Physician specialty was not associated with differences in treatment, but physicians in practice for fewer years ordered more lipid panels.Conclusions: Most patients with CVD in primary care were not receiving cholesterol screening and management as recommended by the National Cholesterol Education Program guidelines in the 2 years after their release. Increasing cholesterol screening and treatment should be a priority for practice quality improvement and could result in significant reductions in CVD events for high-risk patients.