对照冠状动脉心脏病和中风患者的二次预防,参加澳大利亚的全科医院:使用全国电子数据库的横截面研究
Jason Yue1, Samia Kazi1,2, Tu Nguyen1
1Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia.
BMJ quality & safety
|July 24, 2023
概括
对心血管疾病患者的二级预防保健是不理想的,特别是对于中风幸存者而言,与冠状动脉心脏病患者相比. 增加初级保健访问的频率与更好的药物坚持和管理有关.
科学领域:
- 心血管医学 心血管医学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 二次预防对于管理冠状动脉心脏病 (CHD) 和中风至关重要.
- 初级保健的获取和使用的变化可能会影响二次预防策略的有效性.
- 了解这些差异对于优化患者治疗结果至关重要.
研究的目的:
- 为了比较心血管疾病患者的二次预防护理与中风.
- 调查初级保健访问频率和规律性对二次预防的影响.
- 发现处方药和风险因素评估中的差异.
主要方法:
- 澳大利亚电子健康记录 (2016-2020) 的回顾性分析.
- 包括患有心脏病,中风或两种病的患者 (≥18岁),在2年内有≥3次全科医院见面.
- 多变量逻辑回归用于比较处方药 (抗高血压药,抗脂血药,抗血小板药) 和风险因素监测 (血压,LDL-C).
主要成果:
- 与心脏病患者相比,中风患者接受的抗高血压药,抗脂血药和抗血小板药较少.
- 脑卒中患者没有接受推的二次预防药物 (aOR 1.37) 的几率更高,血压和LDL-C (aOR 1.26) 的监测更少.
- 频繁和定期的全科医生接触与改善的二次预防药物处方有显著的关联 (p<0.001).
结论:
- 对心血管疾病的二次预防管理不足,中风患者与心血管疾病患者相比,经历了更糟糕的护理.
- 更频繁和定期的初级保健接触与更好的二次预防结果有关.
- 加强对中风幸存者的初级保健参与的战略是有必要的.
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