Wittchen H-U, Glaesmer H, März W, Stalla G, Lehnert H, Zeiher A M, Silber S, Koch U, Böhler S, Pittrow D, Ruf G
Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Germany.
Curr Med Res Opin. 2005 Apr;21(4):619-30. doi: 10.1185/030079905X38187.
DETECT is an epidemiological study in primary care to examine (a) the prevalence rates and comorbidity of diabetes mellitus, hypertension, hyperlipidaemia and coronary heart disease (CHD), and associated conditions; (b) the frequency of behavioural and clinical risk factors for onset and progression; (c) the 12-month course and outcome; and (d) the met and unmet needs for these patients.
Three-stage, cross-sectional clinical-epidemiological study with a prospective-longitudinal component in a nationally representative sample of N = 3795 primary care settings [response rate (RR): 60.2%] and N = 55518 patients (RR: 95.5%). Patients completed a standardized assessment, including questionnaires for patients and the physician and diagnostic screening measures (i.e. blood pressure, heart rate, body mass index and waist circumference assessments). A subsample of patients (N = 7519) also completed a standardized laboratory screening program and was followed-up after 12 months. Data were weighted to adjust for non-response, regional distribution and attrition.
(1) Doctors and patients sample can be regarded as representative for primary care settings in Germany. (2) The clinician-rated point prevalence of hypertension is highest (35.5%), followed by hyperlipidaemia (29.1%), diabetes (14.1%) and CHD (12.1%); prevalence rates of each disorder as well as their co-incidence rates increase markedly with age. (3) The vast majority (78%) of all patients revealed multiple (3+) behavioural and clinical risk factors.
The findings of DETECT underline the considerable burden for primary care doctors in managing a highly morbid patient population, with predominantly complex risk factor constellations, in routine care. Our data provide, in unprecedented detail, a basis for calculating age-, gender- and risk-group-adjusted risk-factor profiles in routine care.
DETECT是一项在初级保健机构开展的流行病学研究，旨在调查：（a）糖尿病、高血压、高脂血症和冠心病（CHD）的患病率及合并症，以及相关情况；（b）行为和临床危险因素引发疾病及疾病进展的频率；（c）12个月的病程及转归；（d）这些患者已满足和未满足的需求。
采用三阶段横断面临床流行病学研究，并包含前瞻性纵向研究部分，样本来自全国范围内具有代表性的N = 3795个初级保健机构[应答率（RR）：60.2%]以及N = 55518名患者（RR：95.5%）。患者完成了标准化评估，包括患者问卷、医生问卷以及诊断筛查措施（即血压、心率、体重指数和腰围评估）。部分患者子样本（N = 7519）还完成了标准化实验室筛查项目，并在12个月后进行随访。对数据进行加权处理，以校正无应答、地区分布和失访情况。
（1）医生和患者样本可被视为德国初级保健机构的代表性样本。（2）临床医生评定的高血压点患病率最高（35.5%），其次是高脂血症（29.1%）、糖尿病（14.1%）和冠心病（12.1%）；每种疾病的患病率及其合并率均随年龄显著增加。（3）所有患者中的绝大多数（78%）存在多种（3种及以上）行为和临床危险因素。
DETECT的研究结果突显了在日常医疗中，初级保健医生管理患有多种疾病、主要是危险因素组合复杂的患者群体时所面临的巨大负担。我们的数据以前所未有的详细程度，为计算日常医疗中年龄、性别和风险组调整后的危险因素概况提供了依据。
