van der Weijden T, Dansen A, Schouten B J, Knottnerus J A, Grol R P
Department of General Practice, University of Maastricht, The Netherlands.
Qual Health Care. 1996 Dec;5(4):218-22. doi: 10.1136/qshc.5.4.218.
To compare the profiles of those patients selected by general practitioners for measurement of serum cholesterol with the recommended profiles for opportunistic cholesterol testing described in the national practice guidelines published by the Dutch College of General Practitioners.
Retrospective audit of general practitioners' records.
Practice records of 3577 adult patients systematically sampled from 20 general practices.
With criteria set by the national guidelines, the proportion of patients per practice (a) for whom cholesterol testing would be considered justified, and (b) for whom cholesterol testing would be considered unjustified, and the proportion of patients within each of these groups who had had a cholesterol measurement recorded.
Cholesterol tests were performed on 415 (11.7%) of the 3577 patients. National guidelines on the management of hypercholesterolaemia state that a positive cardiovascular risk profile is an indication for cholesterol measurement. Just under one fifth (668) of the patients in this study were recorded as having a positive cardiovascular risk profile, but only 31% of these had had their cholesterol measured. Of the patients without recorded evidence of a positive cardiovascular risk profile cholesterol had been measured in 8%. Restricting the analyses to the age group 18-65 (n = 3060) of whom 12.5% had a positive risk profile, did not improve the results. In practices with a computerised information system 37% of patients with recorded evidence of a positive cardiovascular risk profile had had their cholesterol measured.
Cholesterol testing was not targeted as selectively as recommended by the national guidelines. The major problem was failure to test those likely to benefit. Improving the targeting of cholesterol measurements would undoubtedly increase the workload of general practitioners. If the national guidelines are to have an effect on health promotion the first step must be to increase the proportion of patients with positive cardiovascular risk profiles who get their cholesterol tested. A major factor in successfully selecting cases seems to be that practices are equipped with a computerised medical information system.
比较全科医生选择进行血清胆固醇检测的患者情况，与荷兰全科医生学院发布的国家实践指南中描述的机会性胆固醇检测推荐情况。
对全科医生记录进行回顾性审计。
从20家诊所系统抽样的3577名成年患者的诊疗记录。
根据国家指南设定的标准，每家诊所中（a）胆固醇检测被认为合理的患者比例，以及（b）胆固醇检测被认为不合理的患者比例，以及这些组中每一组有胆固醇检测记录的患者比例。
3577名患者中有415名（11.7%）进行了胆固醇检测。国家高胆固醇血症管理指南指出，心血管风险状况呈阳性是胆固醇检测的指征。本研究中略低于五分之一（668名）的患者记录显示心血管风险状况呈阳性，但其中只有31%进行了胆固醇检测。在没有记录显示心血管风险状况呈阳性证据的患者中，8%进行了胆固醇检测。将分析限制在18 - 65岁年龄组（n = 3060），其中12.5%的人风险状况呈阳性，结果并未改善。在拥有计算机化信息系统的诊所中，有记录显示心血管风险状况呈阳性证据的患者中37%进行了胆固醇检测。
胆固醇检测没有像国家指南推荐的那样有针对性地进行。主要问题是未能对可能受益的患者进行检测。改善胆固醇检测的针对性无疑会增加全科医生的工作量。如果国家指南要对健康促进产生影响，第一步必须是增加心血管风险状况呈阳性的患者接受胆固醇检测的比例。成功选择病例的一个主要因素似乎是诊所配备了计算机化医疗信息系统。
