北卡罗来纳州初级医疗实践中，依据美国国家胆固醇教育计划第三次成人治疗专家组（ATPIII）指南进行胆固醇筛查与管理的质量。

Quality of cholesterol screening and management with respect to the National Cholesterol Education's Third Adult Treatment Panel (ATPIII) guideline in primary care practices in North Carolina.

作者信息

Bertoni Alain G, Bonds Denise E, Steffes Susan, Jackson Eric, Crago Lenore, Balasubramanyam Aarthi, Chen Haiying, Goff David C

机构信息

Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

出版信息

Am Heart J. 2006 Oct;152(4):785-92. doi: 10.1016/j.ahj.2006.04.017.

DOI:10.1016/j.ahj.2006.04.017

PMID:16996859

Abstract

BACKGROUND

Adherence to previous national cholesterol guidelines has been low. We assessed whether lipid screening and management was consistent with the National Cholesterol Education's ATPIII in a sample of primary care practices participating in a quality improvement study.

METHODS

Demographic and clinical data were abstracted from charts of 5071 patients aged 21 to 84 years, which were seen between June 1, 2001, and May 31, 2003, at 60 practices. Clinical sites were non-university-based primary care practices from 22 North Carolina counties. A dyslipidemia screening test was defined as a lipid profile performed on persons when not on a lipid-lowering drug. Among patients receiving a lipid profile, the proportion of patients appropriately treated, per ATPIII, was calculated. Practice level variation in screening and management was examined using the 50th (20th and 80th) percentile values across practices.

RESULTS

The median practice level dyslipidemia screening rate during the 2 years was 40.1% (25.8%, 53.7%) of their age-eligible patients. The appropriate decision regarding lipid-lowering therapy was documented within 4 months of the lipid profile for 79.3% (69.0%, 86.0%) of practices' patients. Within 4 months, among the drug-ineligible patients, 100% (94%, 100%) were not prescribed drugs; 33.3% (6.3%, 50.0%) of the drug-eligible patients were prescribed lipid-lowering agents.

CONCLUSIONS

The median dyslipidemia screening rate met the recommendations. There remains a need to improve the management of dyslipidemia; in particular, there was a significant underprescription of lipid-lowering drugs.

摘要

背景

以往对国家胆固醇指南的遵循率一直很低。我们在参与一项质量改进研究的初级医疗实践样本中，评估了血脂筛查和管理是否符合美国国家胆固醇教育计划成人治疗组第三次报告（ATPIII）。

方法

从60个医疗实践机构在2001年6月1日至2003年5月31日期间诊治的5071名年龄在21至84岁患者的病历中提取人口统计学和临床数据。临床机构为北卡罗来纳州22个县的非大学附属初级医疗实践机构。血脂异常筛查测试定义为对未服用降脂药物的人进行的血脂检测。在接受血脂检测的患者中，计算符合ATPIII标准的适当治疗患者比例。使用各医疗实践机构的第50百分位数（第20和第80百分位数）来检查筛查和管理方面的实践水平差异。

结果

两年期间，各医疗实践机构血脂异常筛查率的中位数为其符合年龄标准患者的40.1%（25.8%，53.7%）。在血脂检测后4个月内，79.3%（69.0%，86.0%）的医疗实践机构患者有关于降脂治疗的适当决策记录。在4个月内，在不符合用药标准的患者中，100%（94%，100%）未开具药物；在符合用药标准的患者中，33.3%（6.3%，50.0%）开具了降脂药物。