Gandara Esteban, Moniz Thomas T, Dolan Mary Lou, Melia Caroline, Dudley Jessica, Smith Allen, Kachalia Allen
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
Crit Pathw Cardiol. 2009 Dec;8(4):139-45. doi: 10.1097/HPC.0b013e3181bc8074.
Patients with chronic diseases often require complex medication regimens to meet evidence-based treatment guidelines. However, translating evidence-based recommendations into clinical care has proven to be difficult. Several factors-patient adherence, disease complexity, competing medical issues, guideline dissemination, and clinical inertia-are thought to contribute to this problem. In this manuscript, we describe a multidisciplinary ambulatory approach to improve the care of patients with chronic conditions. Our goal was to design an intervention that focused on improving the prescription rates of medications known to reduce cardiovascular-related events and hospital admissions for patients with diabetes mellitus, coronary artery disease, heart failure, chronic kidney disease, or stroke. We also describe the critical lessons we have learned in implementing our intervention, including the successes and barriers we encountered during the project.
慢性病患者通常需要复杂的药物治疗方案来符合循证治疗指南。然而，事实证明，将循证推荐转化为临床护理具有挑战性。患者依从性、疾病复杂性、并存的医疗问题、指南传播以及临床惰性等多种因素被认为是导致这一问题的原因。在本手稿中，我们描述了一种多学科门诊方法，以改善慢性病患者的护理。我们的目标是设计一种干预措施，重点提高已知可降低糖尿病、冠状动脉疾病、心力衰竭、慢性肾病或中风患者心血管相关事件和住院率的药物处方率。我们还描述了在实施干预过程中吸取的关键经验教训，包括项目期间遇到的成功之处和障碍。
