Reductions in risk factors for secondary prevention of coronary heart disease by ethnic group in south-west London: 10-year longitudinal study (1998-2007)
Reductions in risk factors for secondary prevention of coronary heart disease by ethnic group in south-west London: 10-year longitudinal study (1998-2007)
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DOI：
10.1093/fampra/cmq030
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发表时间：
2010-08-01
期刊：
影响因子：
2.2
通讯作者：
Majeed, Azeem
中科院分区：
文献类型：
--
作者：
Murray, Joanna;Saxena, Sonia;Majeed, Azeem
设计。从1998年到2007年的纵向研究，使用从2007年登记的所有成年患者的电子病历中提取的全科数据（n = 177412）。伦敦西南部旺兹沃斯的29个全科医生。2007年，有3200名登记的冠心病患者被诊断为冠心病。主要结果测量。冠心病患者每日历年的平均收缩压和舒张压及平均胆固醇。从1998年到2007年，有血压记录的冠心病患者比例从33.2%上升到93.9%，胆固醇从21.7%上升到83.5%。在此期间，平均血压从140/80降至133/74 mmHg （P < 0.001）。平均胆固醇从5.2降至4.3 mmol/l （P < 0.001）。在所有种族人群中，平均血压和胆固醇均有所降低。从1998年到2007年，冠心病患者的风险因素控制得到了改善，所有种族患者的平均血压和胆固醇水平都有所下降。广泛的政策变化有助于提高心脏病患者初级保健的质量和公平性。在实施《质量和成果框架》之前，卫生状况就得到改善，此后一直在继续。我们的研究结果说明了全民覆盖的国家医疗保健系统如何显著减少不平等现象，并改善所有族裔群体的慢性病护理。
Design. Longitudinal study from 1998 to 2007, using general practice data extracted from electronic patient records of all adult patients (n = 177 412) registered in 2007.Setting. Twenty-nine general practices in Wandsworth south-west London.Subjects. Three thousand two hundred registered patients with a recorded diagnosis of CHD, in 2007.Main outcome measures. Mean systolic and diastolic blood pressure and mean cholesterol of patients with CHD, for each calendar year.Results. From 1998 to 2007, the proportion of patients with CHD who had their blood pressure recorded rose from 33.2% to 93.9% and cholesterol from 21.7% to 83.5%. Over this period, mean blood pressure decreased from 140/80 to 133/74 mmHg (P < 0.001). There was a reduction in mean cholesterol from 5.2 to 4.3 mmol/l (P < 0.001). Reductions in mean blood pressure and cholesterol occurred across all ethnic groups.Conclusions. From 1998 to 2007, risk factor control among patients with CHD improved, with reductions in their mean blood pressure and cholesterol across all ethnic groups. Widespread policy change has helped to improve the quality and equity of primary care for heart disease patients. Health improvements predated implementation of the Quality and Outcomes Framework and have since continued. Our findings illustrate how a national health care system with universal coverage can significantly reduce inequalities and improve chronic disease care for all ethnic groups.