Clinical implications of an accurate problem list on heart failure treatment
Clinical implications of an accurate problem list on heart failure treatment
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DOI：
10.1111/j.1525-1497.2005.40206.x
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发表时间：
2005-02-01
影响因子：
5.7
通讯作者：
Touchette, DR
中科院分区：
文献类型：
--
作者：
Hartung, DM;Hunt, J;Touchette, DR
背景：以问题为导向的病案的前提是，准确定义的问题清单将直接导致更彻底和有效的患者护理。然而，很少有经验证据表明，一个结构合理的问题清单改善了患者的治疗效果。目的：确定心力衰竭问题清单文件对循证药物治疗的可能性的影响。设计：横断面研究。地点：俄勒冈州波特兰市社区初级保健诊所。受试者：网络中左心室射血分数在40%或以下的活跃患者，伴有或不伴有心力衰竭，在他们的结构化问题列表中。主要结局指标：处方药物已知对收缩功能障碍有益的患者比例。结果：在这组已知有收缩功能障碍的患者中，有心衰问题列表的患者接受血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂治疗的可能性高于无心衰问题列表的患者（92.2% vs 76.7%; P < 0.05）。在对年龄、性别和射血分数进行统计调整后，这种关联仍然存在。问题清单条目准确的患者也更有可能接受地高辛（61.1%对36.7%，P= 0.001）和螺内酯（26.7%对13.3%，P= 0.025）。两组患者在受体阻滞剂的使用上没有差异。结论：在已知收缩功能障碍患者的问题列表中准确记录心力衰竭与已知临床获益的处方药物的可能性显著增加相关。
CONTEXT: The premise of the problem-oriented medical record is that an accurately defined problem list will directly result in more thorough and efficient patient care. However, little empirical evidence exists demonstrating improved patient outcomes as a result of an adequately structured problem list.OBJECTIVE: To determine the impact of problem list documentation of heart failure on the likelihood that evidence-based pharmacotherapy has been prescribed.DESIGN: Cross-sectional study.SETTING: Community-based primary care clinics in Portland, Oregon.SUBJECTS: Active patients in the network with a left ventricular ejection fraction of 40% or less, with and without heart failure, in their structured problem list.MAIN OUTCOME MEASURES: The proportion of patients prescribed medications with known benefits for systolic dysfunction.RESULTS: In this group of patients with known systolic dysfunction, the likelihood of therapy with either an angiotensin converting enzyme inhibitor or angiotensin II receptor blocker was higher in patients who had heart failure listed on their problem list compared to patients who did not ( 92.2% vs 76.7%; P < .05). This association remained after statistical adjustment for age, gender, and ejection fraction. Patients with accurate problem list entries were also more likely to receive digoxin (61.1% vs 36.7%; P=.001) and spironolactone (26.7% vs 13.3%; P=.025). There were no differences in the use of beta-blockers between the 2 groups.CONCLUSION: Accurate documentation of heart failure on the problem list of patients with known systolic dysfunction is associated with a significant increase in the likelihood of being prescribed medications with known clinical benefit.