Go A S, Rao R K, Dauterman K W, Massie B M
Division of Research, Kaiser Permanente Medical Care Program (Northern California), Oakland, California 94611-5714, USA.
Am J Med. 2000 Feb 15;108(3):216-26. doi: 10.1016/s0002-9343(99)00430-1.
To assess the effects of physician specialty on the knowledge, management, and outcomes of patients with coronary disease or heart failure.
We performed a systematic search of MEDLINE from 1980 to 1997, as well as bibliographic references to articles about the effects of physician specialty on the knowledge, treatment, and outcomes of patients with coronary disease or heart failure in the United States.
Twenty-four articles met our criteria for inclusion (including eight that involved knowledge or self-reported practices, 14 that described actual practice patterns, and six that measured clinical outcomes). Cardiologists were more knowledgeable than generalist physicians about the optimal evaluation and management of coronary disease but not about the use of angiotensin-converting enzyme (ACE) inhibitors for heart failure. Patients with unstable angina or myocardial infarction were more likely to receive proven medical therapies, and possibly had improved outcomes, if they were treated by cardiologists. The use of lipid-lowering drugs after myocardial infarction was also more common among patients of cardiologists. ACE inhibitor use for heart failure was probably greater, and short-term readmission rates were lower, with cardiology care.
Patients with coronary disease or heart failure in the United States who are treated by cardiologists appear more likely to receive evidence-based care and probably have better outcomes. Investigation of collaborative models of care and innovative efforts to improve the use of proven therapies by physicians are needed.
评估医生专业对冠心病或心力衰竭患者的知识、管理及治疗结果的影响。
我们对1980年至1997年的MEDLINE进行了系统检索，并查阅了有关美国医生专业对冠心病或心力衰竭患者的知识、治疗及治疗结果影响的文章的参考文献。
24篇文章符合我们的纳入标准（包括8篇涉及知识或自我报告做法的文章、14篇描述实际治疗模式的文章以及6篇衡量临床结果的文章）。心脏病专家在冠心病的最佳评估和管理方面比全科医生知识更丰富，但在使用血管紧张素转换酶（ACE）抑制剂治疗心力衰竭方面并非如此。不稳定型心绞痛或心肌梗死患者若由心脏病专家治疗，更有可能接受经过验证的药物治疗，且治疗结果可能更好。心肌梗死后使用降脂药物在心脏病专家的患者中也更为常见。接受心脏病治疗时，ACE抑制剂用于心力衰竭的情况可能更多，短期再入院率更低。
在美国，由心脏病专家治疗的冠心病或心力衰竭患者似乎更有可能接受循证治疗，且治疗结果可能更好。需要对协作治疗模式进行调查，并做出创新努力以提高医生对经过验证的治疗方法的使用。
