National study of physician awareness and adherence to cardiovascular disease prevention guidelines
National study of physician awareness and adherence to cardiovascular disease prevention guidelines
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DOI：
10.1161/01.cir.0000154568.43333.82
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发表时间：
2005-02-01
期刊：
影响因子：
37.8
通讯作者：
Simpson, SL
中科院分区：
文献类型：
--
作者：
Mosca, L;Linfante, AH;Simpson, SL
背景 - 很少有数据根据医生专业或患者特征（特别是性别）评估医生对心血管疾病 (CVD) 预防指南的遵守情况。 方法和结果 - 一项针对 500 名随机选择的医生（300 名初级保健医生、100 名妇产科医生和 100 名心脏病专家）的在线研究使用标准化问卷来评估各专业对国家 CVD 预防指南的认识、采用和障碍。一项实验性案例研究设计测试了医生对高、中或低风险患者的 CVD 风险级别分配和指南应用的准确性和决定因素。根据弗雷明汉风险评分评估，中等风险女性比具有相同风险状况的男性更有可能被初级保健医生分配到较低风险类别（P < 0.0001），妇产科医生和心脏病专家的趋势相似。风险水平的分配显着预测了生活方式和预防性药物治疗的建议。调整风险分配后，除了建议中危女性减少阿司匹林用量（P < 0.01）和加强体重管理（P < 0.04）外，患者性别对预防保健的影响并不显着。医生们并不认为自己在帮助患者预防心血管疾病方面非常有效。不到五分之一的医生知道每年死于 CVD 的女性多于男性。结论 - 对风险的认知是与 CVD 预防建议相关的主要因素。预防性治疗建议中的性别差异主要是由于尽管女性与男性的计算风险相似，但感知风险较低。需要对医生进行教育干预，以提高心血管疾病预防护理的质量，并降低男性和女性心血管疾病的发病率和死亡率。
Background - Few data have evaluated physician adherence to cardiovascular disease (CVD) prevention guidelines according to physician specialty or patient characteristics, particularly gender.Methods and Results - An online study of 500 randomly selected physicians ( 300 primary care physicians, 100 obstetricians/gynecologists, and 100 cardiologists) used a standardized questionnaire to assess awareness of, adoption of, and barriers to national CVD prevention guidelines by specialty. An experimental case study design tested physician accuracy and determinants of CVD risk level assignment and application of guidelines among high-, intermediate-, or low-risk patients. Intermediate-risk women, as assessed by the Framingham risk score, were significantly more likely to be assigned to a lower-risk category by primary care physicians than men with identical risk profiles ( P < 0.0001), and trends were similar for obstetricians/gynecologists and cardiologists. Assignment of risk level significantly predicted recommendations for lifestyle and preventive pharmacotherapy. After adjustment for risk assignment, the impact of patient gender on preventive care was not significant except for less aspirin ( P < 0.01) and more weight management recommended ( P < 0.04) for intermediate- risk women. Physicians did not rate themselves as very effective in their ability to help patients prevent CVD. Fewer than 1 in 5 physicians knew that more women than men die each year from CVD.Conclusions - Perception of risk was the primary factor associated with CVD preventive recommendations. Gender disparities in recommendations for preventive therapy were explained largely by the lower perceived risk despite similar calculated risk for women versus men. Educational interventions for physicians are needed to improve the quality of CVD preventive care and lower morbidity and mortality from CVD for men and women.