Peiris David, Murray Jonathan, Scully Doreen, Tilakawardene Virantha, Hetaraka-Stevens Lorraine, Stewart Tereki, Patel Anushka
The George Institute For International Health, PO Box M201 Missenden Rd NSW 2050, Sydney, Australia.
N Z Med J. 2008 Nov 7;121(1285):35-46.
To examine the cardiovascular disease (CVD) risk profile and management for the first 12 months of an electronic risk assessment program at Tamaki Healthcare, Auckland.
An audit of risk assessment and medication data supplemented by a manual case record review.
1522 people were screened representing around 15.5% of the eligible population. Of the 1420 people with data available, 248 (17.5%) had a calculated 5-year CVD risk > or = 15% and another 177 (12.5%) had previous CVD. Maori were significantly more likely to be at high CVD risk than non-Maori (OR 2.07 (1.51-2.84); p<0.001). For Pacific peoples (mostly of Samoan, Tongan, Niuean, Fijian, or Cook Islands origin) there was no increased likelihood of high CVD risk. Medication data were available for 399 (95.5%) people at high CVD risk. Prescribing rates for this group were 78.1% for blood pressure lowering, 71.9% for lipid-lowering, 65.3% for anti-platelet ,and 50.3% for all three therapies. Whilst this group may represent the better end of the management spectrum, success in achieving treatment targets was modest. For 451 people with either diabetes or established CVD, 65.9% and 66.1% were not meeting blood pressure and lipid management recommendations respectively. There were very few disparities in prescribing rates and attainment of target levels by ethnic group.
This study has shown that a primary care electronic risk assessment program can be rapidly implemented within 12 months. Although the sample may not be representative due to a small proportion screened so far, major disparities in risk factor prevalence rates were found- particularly for Maori. Furthermore, substantial guideline-practice gaps were encountered in the appropriate prescribing of cardiovascular medicines and attainment of recommended targets. Several Tamaki Healthcare initiatives to address these findings are discussed.
研究奥克兰塔玛基医疗中心电子风险评估项目前12个月的心血管疾病（CVD）风险概况及管理情况。
通过人工病历审查对风险评估和用药数据进行审计。
共筛查了1522人，约占符合条件人群的15.5%。在有数据的1420人中，248人（17.5%）计算得出的5年心血管疾病风险≥15%，另有177人（12.5%）曾患心血管疾病。毛利人患心血管疾病高风险的可能性显著高于非毛利人（比值比2.07（1.51 - 2.84）；p<0.001）。对于太平洋岛民（主要来自萨摩亚、汤加、纽埃、斐济或库克群岛），患心血管疾病高风险的可能性并未增加。有399名（95.5%）心血管疾病高风险患者有用药数据。该组的降压药处方率为78.1%，降脂药为71.9%，抗血小板药为65.3%，三种疗法都用的为50.3%。虽然该组可能代表了管理范围中较好的一端，但实现治疗目标的成功率并不高。对于451名患有糖尿病或已确诊心血管疾病的患者，分别有65.9%和66.1%未达到血压和血脂管理建议。不同种族在处方率和目标水平达成方面差异很小。
本研究表明，初级保健电子风险评估项目可在12个月内迅速实施。尽管由于目前筛查比例较小，样本可能不具代表性，但发现了危险因素患病率的重大差异——尤其是毛利人。此外，在心血管药物的合理处方和达到推荐目标方面存在较大的指南 - 实践差距。讨论了塔玛基医疗中心为解决这些发现而采取的多项举措。
