Eaton Charles B, Galliher James M, McBride Patrick E, Bonham Aaron J, Kappus Jennifer A, Hickner John
Brown University Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI, USA.
J Am Board Fam Med. 2006 Jan-Feb;19(1):46-53. doi: 10.3122/jabfm.19.1.46.
Family physicians have the potential to make a major impact on reducing the burden of cardiovascular disease through the optimal assessment and management of hyperlipidemia. We were interested in assessing the knowledge, beliefs, and self-reported practice patterns of a representative sample of family physicians regarding the assessment and management of hyperlipidemia 2 years after the release of the evidence-based National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines.
A 33-item survey was mailed to a random sample (N = 1200) of members of the American Academy of Family Physicians in April of 2004, with 2 follow-up mailings to nonresponders. Physicians were queried about sociodemographic characteristics, their knowledge, attitudes, and self-reported practice patterns regarding the assessment and management of hyperlipidemia. Four case scenarios also were presented.
Response rate was 58%. Over 90% of surveyed family physicians screened adults for hyperlipidemia as part of a cardiovascular disease prevention strategy. Most (89%) did this screening by themselves without the support of office staff, and 36% reported routine use of a flow sheet. Most had heard of the ATP III guidelines (85%), but only 13% had read them carefully. Only 17% of respondents used a coronary heart disease (CHD) risk calculator usually or always. Over 90% of those responding reported using low-density lipoprotein (LDL) as the treatment goal but only 76% reported using non-high-density lipoprotein (HDL) cholesterol as a secondary goal of therapy.
We found a large variability in knowledge, beliefs, and practice patterns among practicing family physicians. We found general agreement on universal screening of adults for hyperlipidemia as part of cardiovascular disease prevention strategy and use of LDL cholesterol as a treatment goal. Many other aspects of the NCEP ATP III guidelines, such as use of a systematic, multidisciplinary approach, using non-HDL cholesterol as a secondary goal, routinely using a CHD risk calculator for risk assessment to guide cholesterol management, have not yet penetrated into self-reported clinical practice.
家庭医生有潜力通过对高脂血症进行最佳评估和管理，对减轻心血管疾病负担产生重大影响。我们感兴趣的是评估在基于证据的国家胆固醇教育计划（NCEP）成人治疗小组（ATP）III指南发布两年后，具有代表性的家庭医生样本对于高脂血症评估和管理的知识、信念及自我报告的实践模式。
2004年4月，向美国全科医生学会成员的随机样本（N = 1200）邮寄了一份包含33个项目的调查问卷，并对未回复者进行了2次跟进邮寄。询问医生的社会人口统计学特征、他们关于高脂血症评估和管理的知识、态度及自我报告的实践模式。还呈现了4个病例场景。
回复率为58%。超过90%的受访家庭医生将对成年人进行高脂血症筛查作为心血管疾病预防策略的一部分。大多数（89%）是在没有办公室工作人员支持的情况下自行进行此项筛查的，36%报告常规使用流程图。大多数人听说过ATP III指南（85%），但只有13%仔细阅读过。只有17%的受访者通常或总是使用冠心病（CHD）风险计算器。超过90%的回复者报告使用低密度脂蛋白（LDL）作为治疗目标，但只有76%报告使用非高密度脂蛋白（HDL）胆固醇作为治疗的次要目标。
我们发现执业家庭医生在知识、信念和实践模式方面存在很大差异。我们发现，作为心血管疾病预防策略的一部分，对成年人进行普遍高脂血症筛查以及将LDL胆固醇作为治疗目标方面存在普遍共识。NCEP ATP III指南的许多其他方面，例如使用系统的多学科方法、将非HDL胆固醇作为次要目标、常规使用CHD风险计算器进行风险评估以指导胆固醇管理等，尚未渗透到自我报告的临床实践中。
