Athyros V G, Karagiannis A, Hatzitolios A I, Paletas K, Savopoulos C, Giannoglou G, Mikhailidis D P
Atherosclerosis and Metabolic Syndrome Units, 2nd Propedeutic Department of Internal Medicine, Aristotelian University, Hippocration Hospital, Thessaloniki, Greece.
Curr Med Res Opin. 2009 Apr;25(4):971-80. doi: 10.1185/03007990902810999.
To substantially increase awareness, treatment and effective control of the metabolic syndrome (MetS) and its components.
This is a pilot best practice implementation enhancement programme to reduce the estimated cardiovascular disease (CVD) risk in 628 MetS patients with or without diabetes or CVD by improving quality of care. A baseline visit was followed by action to improve adherence to lifestyle advice and drug treatment for CVD risk factors by physicians specifically trained to implement guidelines. Finally, after 6 months, a single-page form was completed, showing if patients were at CVD risk factor target. If not, there was an analysis of the reason why.
The programme was effective in improving utilization of evidence-based treatment in 628 MetS patients. There was a substantially greater patient perception of MetS, an enhancement in compliance with lifestyle advice and increased prescription of evidence-based medication, leading to a 48% (p < 0.0001) improvement in estimated CVD risk. There was a substantial increase in the number of subjects on target for specific CVD risk factors.
This is the first study to increase adherence to multiple interventions for all MetS components on an outpatient basis, in both primary care and teaching hospital settings. Physician and patient education, distribution of printed guidelines and brochures, and completion of a single-page form motivated both physicians and patients to achieve multiple CVD risk factor guideline goals. The absence of a control group is a limitation of this study. Further work is also needed to establish if the improvements observed are sustained on a long-term basis.
大幅提高对代谢综合征（MetS）及其各组分的认知、治疗和有效控制。
这是一项试点最佳实践实施强化项目，旨在通过改善医疗质量，降低628例患有或未患有糖尿病或心血管疾病（CVD）的MetS患者的预估心血管疾病风险。在进行基线访视后，由经过专门培训以实施指南的医生采取行动，提高对生活方式建议的依从性以及针对CVD风险因素的药物治疗。最后，在6个月后，填写一份单页表格，显示患者是否达到CVD风险因素目标。如果未达到，则分析原因。
该项目在改善628例MetS患者基于证据的治疗利用方面有效。患者对MetS的认知显著提高，对生活方式建议的依从性增强，基于证据的药物处方增加，导致预估CVD风险改善48%（p < 0.0001）。特定CVD风险因素达标的受试者数量大幅增加。
这是第一项在门诊基础上，在初级保健和教学医院环境中提高对所有MetS组分多种干预措施依从性的研究。医生和患者教育、印刷指南和宣传册的分发以及单页表格的填写促使医生和患者实现多个CVD风险因素指南目标。本研究的一个局限性是没有对照组。还需要进一步开展工作，以确定观察到的改善是否能长期持续。
