Maiman L A, Greenland P, Hildreth N G, Cox C
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, New York.
Am J Prev Med. 1991 Sep-Oct;7(5):273-9.
Current interest in high blood cholesterol and attendance at public cholesterol screening programs has raised the issue of whether physicians are responding to referrals according to existing national assessment and treatment recommendations. This study assessed the relationship of characteristics of referrals from a series of public blood cholesterol screenings to physicians' treatment practices. For this analysis, the sample was restricted to 1,324 subjects, from the 2,109 referred, who reported seeking physician care. At five months after screening, 75% of subjects reported their physician prescribed a diet; 16% of physicians prescribed medication. Multiple logistic regression, adjusted for sociodemographic characteristics and other coronary heart disease (CHD) risk factors, indicated that screening cholesterol risk level, prior history of high blood cholesterol levels, and type of medical contact were consistently related to receipt of diet and medication treatment, but other CHD risk factors were underutilized. "Moderate" risk subjects with no history of high blood cholesterol were less likely to have received dietary advice, but a screening-risk level interaction did not occur for medication. The results imply that current treatment guidelines may not be working and suggest the need for continued physician education in the management of hypercholesterolemia.
当前对高血胆固醇的关注以及公众胆固醇筛查项目的参与度，引发了一个问题：医生是否按照现有的国家评估和治疗建议对转诊进行处理。本研究评估了一系列公共血液胆固醇筛查的转诊特征与医生治疗实践之间的关系。在本次分析中，样本仅限于2109名转诊者中报告寻求医生治疗的1324名受试者。在筛查后五个月，75%的受试者报告其医生开了饮食处方；16%的医生开了药物处方。在对社会人口学特征和其他冠心病（CHD）危险因素进行调整后，多元逻辑回归表明，筛查胆固醇风险水平、既往高血胆固醇水平病史以及医疗接触类型与饮食和药物治疗的接受情况始终相关，但其他CHD危险因素未得到充分利用。没有高血胆固醇病史的“中度”风险受试者接受饮食建议的可能性较小，但药物治疗未出现筛查风险水平交互作用。结果表明，当前的治疗指南可能未发挥作用，并提示在高胆固醇血症管理方面持续开展医生教育的必要性。
