Dubhghaill C T O, Moonen L, O'Loughlin A, O'Keeffe S, Egan D, Murphy A W
Spiddal Medical Centre, Spiddal, Co. Galway.
Ir Med J. 2003 Nov-Dec;96(10):296-9.
There is evidence that patients with atrial fibrillation (AF) are not being anticoagulated according to the published guidelines. Difficulty in identifying such patients may partly explain this. In this study, we examined the yield of different methods for detecting people with AF in a single general practice: hospital discharge letters, referrals to cardiology, staff recall of cases, records of relevant prescriptions from the local pharmacist and similar records from the GMS Payments Board. A review of all files of patients over 45 was undertaken as the definitive method of case identification. Recommended anticoagulation guidelines were applied using structured patient interviews. The practice population was 5,473. Sixty-eight patients with AF were identified giving a practice prevalence of 1.2%. The GMS Payment Board records for the prescribing of all specified medications was the most sensitive method (58.8%) with a positive predictive value of 21.6%. Of nine patients without cognitive impairment at consultation, four (44.4%) opted to change to the recommended treatment. Reluctance of patients to adopt current treatment guidelines points to the need for further work in this area.
有证据表明，房颤（AF）患者并未按照已发表的指南进行抗凝治疗。难以识别此类患者可能是部分原因。在本研究中，我们在一家普通诊所检验了检测房颤患者的不同方法的效果：医院出院信件、转介至心脏病科的病例、工作人员对病例的回忆、当地药剂师的相关处方记录以及全科医疗服务支付委员会的类似记录。对所有45岁以上患者的档案进行审查作为病例识别的确定性方法。使用结构化患者访谈应用推荐的抗凝指南。该诊所的人口为5473人。确定了68例房颤患者，诊所患病率为1.2%。全科医疗服务支付委员会关于所有指定药物处方的记录是最敏感的方法（58.8%），阳性预测值为21.6%。在会诊时无认知障碍的9例患者中，4例（44.4%）选择改用推荐治疗。患者不愿采用当前治疗指南表明该领域需要进一步开展工作。
