基于网络的心血管疾病(CVD)风险评估程序会增加对毛利人心血管疾病风险因素的评估吗?
Will a web-based cardiovascular disease (CVD) risk assessment programme increase the assessment of CVD risk factors for Maori?
作者信息
Whittaker Robyn, Bramley Dale, Wells Sue, Stewart Alistair, Selak Vanessa, Furness Sue, Rafter Natasha, Roseman Paul, Jackson Rod
机构信息
Health Gain Team, Waitemata District Health Board, Takapuna, Auckland.
出版信息
N Z Med J. 2006 Jul 21;119(1238):U2077.
BACKGROUND
Maori suffer disproportionately from cardiovascular disease despite the national priority of reducing inequalities. National guidelines on the clinical management of CVD risk recommend a comprehensive risk assessment be completed as a prerequisite for identifying patients most likely to benefit from treatment.
METHODS
A retrospective audit of GPs using PREDICT-CVD (an electronic risk assessment and management tool) was designed with adequate explanatory power for Maori to determine if it could increase CVD risk assessment without increasing inequalities. 1680 electronic medical records (EMRs) prior to implementation and 1884 after implementation of PREDICT were audited.
RESULTS
Documentation of CVD risk increased from 3.2% of EMRs to 14.7% of EMRs in Maori, and from 2.8% to 10.5% in non-Maori. The documentation of individual CVD risk factors also increased post-implementation of the tool.
CONCLUSIONS
The implementation of PREDICT-CVD was as likely to increase documentation of CVD risk assessment and risk factors in Maori as in non-Maori. However documentation was still low in Maori despite known high prevalence of CVD risk factors. A comprehensive quality-driven implementation programme is recommended, including targeting risk assessment for those most in need.
背景
尽管国家将减少不平等作为优先事项,但毛利人患心血管疾病的比例却过高。心血管疾病风险临床管理的国家指南建议,作为识别最可能从治疗中受益的患者的先决条件,应完成全面的风险评估。
方法
设计了一项对使用PREDICT-CVD(一种电子风险评估和管理工具)的全科医生进行的回顾性审计,该审计对毛利人具有足够的解释力,以确定它是否可以在不增加不平等的情况下提高心血管疾病风险评估。对实施PREDICT之前的1680份电子病历(EMR)和实施之后的1884份电子病历进行了审计。
结果
毛利人电子病历中记录的心血管疾病风险从3.2%增加到14.7%,非毛利人从2.8%增加到10.5%。该工具实施后,个体心血管疾病风险因素的记录也有所增加。
结论
实施PREDICT-CVD在增加毛利人和非毛利人心血管疾病风险评估及风险因素记录方面的可能性相同。然而,尽管已知心血管疾病风险因素的患病率很高,但毛利人的记录仍然很低。建议实施一项全面的质量驱动型实施计划,包括针对最需要的人群进行风险评估。