Physician adherence to blood pressure guidelines and its effect on seniors
Physician adherence to blood pressure guidelines and its effect on seniors
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DOI：
10.1592/phco.28.7.843
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发表时间：
2008-07-01
期刊：
影响因子：
4.1
通讯作者：
Franciscus, Carrie L.
中科院分区：
文献类型：
--
作者：
Milchak, Jessica L.;Carter, Barry L.;Franciscus, Carrie L.
研究目的。比较 65 岁以下患者与 65 岁及以上患者对国家高血压预防、检测、评估和治疗联合委员会第七次报告指南的遵守情况，并分析因素分组（用于确定依从性的标准子集）是否可预测血压控制。设计。回顾性病历审查。设置。五个大学附属家庭医学和内科门诊。患者。 179 名未受控制的高血压患者（年龄范围 21-85 岁）：105 名患者年龄小于 65 岁（非老年），74 名患者年龄在 65 岁或以上（老年）。测量和主要结果。从每位患者的病历中提取的数据用于评估对 17 项护理流程标准的遵守情况，这些标准旨在评估医生对指南的遵守情况。计算机算法生成每个标准的分数以及总体遵守分数。然后检查依从性评分和血压控制之间的关系。进行单独的因素分析以确定标准分组方式的差异。计算每位患者的因素评分，并在血压控制的背景下评估评分。非老年患者的指南依从性评分显着高于老年患者（59.3% vs 56.1%，p=0.024）。非老年人的血压控制率也较高，但不显着；与老年人相比（68.6% vs 56.8%，p=0.063）。老年组中没有任何因素与血压控制显着相关，但非老年组中有一个因素与血压控制显着相关（p
Study Objective. To compare physician adherence to guidelines from the Seventh Report of the joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure for patients younger than 65 years of age with those aged 65 years and older, and to analyze whether factor groupings (subsets of criteria used to determine adherence) were predictive of blood pressure control.Design. Retrospective medical record review.Setting. Five university-affiliated family medicine and internal medicine outpatient clinics.Patients. One hundred seventy-nine patients (age range 21-85 yrs) with uncontrolled hypertension: 105 patients were younger than 65 years (nonsenior), and 74 patients were 65 years or older (senior).Measurements and Main Results. Data abstracted from each patients medical record were used to evaluate adherence to 17 process-of-care criteria, identified to assess physician adherence to the guidelines. A computer algorithm generated scores for each criterion as well as an overall adherence score. The relationship between the adherence score and blood pressure control was then examined. Separate factor analyses were conducted to ascertain differences in the way that the criteria were grouped. Factor scores were calculated for each patient, and the scores were evaluated in the context of blood pressure control. Guideline adherence scores were significantly higher for nonsenior patients than for senior patients (59.3% vs, 56.1%, p=0.024). Blood pressure control rate was also higher, although not significantly, in nonseniors; versus seniors (68.6% vs 56.8%, p=0.063). No factors in the senior group were significantly associated with blood pressure control, but one was significantly correlated in the nonsenior group (p