Riddell Tania, Jackson Rod T, Wells Susan, Broad Joanna, Bannink Lot
Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland.
N Z Med J. 2007 Mar 2;120(1250):U2445.
To describe the cardiovascular disease risk factor status and risk management of Māori compared with non-Māori patients opportunistically assessed in routine practice using PREDICT-CVD, an electronic clinical decision support programme.
In August 2002, a primary healthcare organisation, ProCare, implemented PREDICT-CVD as an opportunistic cardiovascular risk assessment and management programme. Between 2002 and February 2006, over 20,000 cardiovascular risk assessments were undertaken on Māori and non-Māori patients. Odds ratios and mean differences in cardiovascular risk factors and risk management for Māori compared to non-Māori (European and other, Pacific, Indian, and other Asian) patients were calculated.
Baseline risk assessments were completed for 1450 (7%) Māori patients and 19, 164 (93%) non-Māori patients. On average, Māori were risk assessed 3 years younger than non-Māori. Māori patients were three times more likely to be smokers, had higher blood pressure and TC/HDL levels, and twice the prevalence of diabetes and history of cardiovascular disease as non-Māori. Among patients with a personal history of cardiovascular disease, Māori were more likely than non-Māori to receive anticoagulants, blood pressure-lowering and lipid-lowering medications. However, of those patients with a history of ischaemic heart disease, Māori were only half as likely as non-Māori to have had a revascularisation procedure.
An electronic decision support programme can be used to systematically generate cardiovascular disease risk burden and risk management data for Māori and non-Māori populations in routine clinical practice in real-time. Moreover, the PREDICT-CVD programme has established one of the largest cohorts of Māori and non-Māori ever assembled in New Zealand. Initial findings suggest that Māori are more likely than non-Māori to receive drug-based cardiovascular risk management if they have a personal history of cardiovascular disease. In contrast, among the subgroup of patients with a history of ischaemic heart disease, Māori appear to receive significantly fewer revascularisations than non-Māori.
使用电子临床决策支持程序PREDICT-CVD，描述在常规医疗中接受机会性评估的毛利人与非毛利人患者的心血管疾病风险因素状况及风险管理情况。
2002年8月，一家初级医疗保健机构ProCare实施了PREDICT-CVD，作为一项机会性心血管风险评估与管理计划。在2002年至2006年2月期间，对毛利人和非毛利人患者进行了超过20000次心血管风险评估。计算了毛利人与非毛利人（欧洲及其他、太平洋岛民、印度裔和其他亚裔）患者在心血管风险因素及风险管理方面的比值比和平均差异。
为1450名（7%）毛利患者和19164名（93%）非毛利患者完成了基线风险评估。平均而言，毛利人接受风险评估的年龄比非毛利人小3岁。毛利患者吸烟的可能性是非毛利人的三倍，血压和总胆固醇/高密度脂蛋白水平更高，糖尿病患病率和心血管疾病病史是非毛利人的两倍。在有心血管疾病个人史的患者中，毛利人比非毛利人更有可能接受抗凝剂、降压药和降脂药治疗。然而，在有缺血性心脏病病史的患者中，毛利人接受血运重建手术的可能性仅为非毛利人的一半。
电子决策支持程序可用于在常规临床实践中实时系统地生成毛利人和非毛利人群体的心血管疾病风险负担及风险管理数据。此外，PREDICT-CVD计划建立了新西兰有史以来最大的毛利人和非毛利人队列之一。初步研究结果表明，如果毛利人有心血管疾病个人史，他们比非毛利人更有可能接受基于药物的心血管风险管理。相比之下，在有缺血性心脏病病史的患者亚组中，毛利人接受血运重建手术的次数似乎明显少于非毛利人。
