评估结构上处于不利地位的群体接受截肢手术的最佳医疗疗法的接受情况
Brandi M Mize1, Ammer Saati2, Maja Wichhart Donzo3
1Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Surgical and Perioperative Care, Atlanta VA Healthcare System, Decatur, GA.
Annals of vascular surgery
|September 29, 2024
概括
对于外周动脉疾病 (PAD) 的最佳医学治疗 (OMT) 可以减少截肢和死亡率. 这项研究发现邻里贫困 (区域贫困指数) 和种族在重大截肢前没有影响OMT接收.
科学领域:
- 血管外科 血管外科
- 健康差异 在健康上的差异
- 公共卫生 公共卫生
背景情况:
- 对外围动脉疾病 (PAD) 进行最佳医学治疗 (OMT) 对于降低主要截肢和死亡率至关重要.
- OMT的关键组成部分包括抗血小板治疗,高强度他类药物和血压管理.
- 已知OMT接收的现有差异,但通过区域贫困指数 (ADI) 衡量的社区社会经济地位的影响仍然不清楚.
研究的目的:
- 调查社区社会经济地位 (高ADI) 和非西班牙裔黑人 (NHB) 种族与接受下肢截肢的主要患者OMT之间的关联.
- 为了确定居住在弱势社区的患者是否不太可能在截肢前接受OMT.
主要方法:
- 在2015年至2019年期间,在两个学术医疗保健系统中,对354名经历了主要下肢截肢的患者进行了回顾性审查.
- 暴露变量包括高ADI (≥60百分位) 和NHB种族.
- 主要结局是接受OMT (抗血小板剂和高强度他),通过多变量逻辑回归来评估.
主要成果:
- 总体而言,尽管进行了血管外科手术咨询,但只有25.7%的患者接受了OMT.
- 高的ADI没有与OMT接收相关 (aOR0.72,95%CI0.42-1.24)).
- NHB比赛也与OMT接收无关;在不同类型的设施中,研究结果是一致的.
结论:
- 根据ADI的指标,邻里经济状况似乎不会影响面临重大截肢的患者接受OMT.
- 尽管没有观察到的社会经济差异,但整体的OMT率较低是不理想的.
- 评估护理流程和制定质量措施至关重要,以加强对患有截肢风险的PAD患者的OMT治疗.
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