Sex Differences in Patient and Provider Response to Elevated Low-Density Lipoprotein Cholesterol
Sex Differences in Patient and Provider Response to Elevated Low-Density Lipoprotein Cholesterol
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DOI：
10.1016/j.whi.2014.06.004
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发表时间：
2014-09-01
影响因子：
3.2
通讯作者：
Dziura, James
中科院分区：
文献类型：
--
作者：
Haskell, Sally G.;Bathulapalli, Harini;Dziura, James
背景资料：尽管美国心脏协会建议饮食/生活方式改变和他汀类药物治疗以实现低密度脂蛋白胆固醇（LDL）控制，但女性接受筛查和实现治疗目标的可能性低于男性。这项研究确定了退伍军人中提供者和患者对LDL升高的电子病历（EMR）通知的反应是否因患者性别而异。提供者对EMR临床提醒LDL升高的反应（>= 100 mg/dL）在男性中进行了评估（n = 40，738）和女性（n = 1，025）退伍军人缺血性心脏病或糖尿病之间的2008年10月和2009年9月。反应分为四种类型：1）患者是否拒绝药物治疗，2）提供者订购或调整药物治疗，3）治疗推迟/药物未改变，或4）药物禁忌。采用广义估计方程的Logistic回归分析比较了男性和女性患者的临床提醒反应。结果：提供者不太可能为女性订购或调整药物（调整后的比值比[OR]，0.75; 95%CI，0.63，0.88），女性比男性更可能拒绝药物治疗（调整后的OR，1.71; 95%CI，1.34，2.17）。这些协会没有修改的程度LDL升高或使用降脂药物。结论：这些结果表明，较差的胆固醇控制在风险妇女可能是一个后果，提供者和患者的因素。爱思唯尔公司出版
Background: Despite American Heart Association recommendations of diet/lifestyle modification and statin therapy to achieve low-density lipoprotein cholesterol (LDL) control, women are less likely than men to be screened and achieve treatment goals. This study determined whether the provider and patient response to electronic medical record (EMR) notification of an elevated LDL varied by patient sex in veterans.Methods: Provider responses to EMR clinical reminders for an elevated LDL (>= 100 mg/dL) were assessed in men (n = 40,738) and women (n = 1,025) veterans with ischemic heart disease or diabetes between October 2008 and September 2009. Responses were classified into four types: 1) Whether the patient refused medication, 2) the provider ordered or adjusted medication, 3) treatment was deferred/medications were not changed, or 4) medications were contraindicated. Logistic regression with generalized estimating equations was used to compare clinical reminder responses between men and women patients.Findings: Providers were less likely to order or adjust medications for women (adjusted odds ratio [OR], 0.75; 95% CI, 0.63, 0.88) and women were more likely than men to refuse medication (adjusted OR, 1.71; 95% CI, 1.34, 2.17). These associations were not modified by degree of LDL elevation or use of lipid-lowering medications.Conclusion: These results indicate that poorer cholesterol control in at risk women is likely a consequence of both provider and patient factors. Published by Elsevier Inc.