心力衰竭患者自我报告和实际β受体阻滞剂处方：医生预测因素。
Self-reported and actual beta-blocker prescribing for heart failure patients: physician predictors.
机构信息
Department of Medicine, James J. Peters VA Medical Center, Bronx, New York, USA.
出版信息
PLoS One. 2009 Dec 31;4(12):e8522. doi: 10.1371/journal.pone.0008522.
BACKGROUND
Beta-blockers reduce mortality among patients with systolic heart failure (HF), yet primary care provider prescription rates remain low.
OBJECTIVE
To examine the association between primary care physician characteristics and both self-reported and actual prescription of beta-blockers among patients with systolic HF.
DESIGN
Cross-sectional survey with supplementary retrospective chart review.
PARTICIPANTS
Primary care providers at three New York City Veterans Affairs medical centers.
MEASUREMENTS
MAIN OUTCOMES WERE: 1) self-reported prescribing of beta-blockers, and 2) actual prescribing of beta-blockers among HF patients. Physician HF practice patterns and confidence levels, as well as socio-demographic and clinical characteristics, were also assessed.
RESULTS
Sixty-nine of 101 physicians (68%) completed the survey examining self-reported prescribing of beta-blockers. Physicians who served as inpatient ward attendings self-reported significantly higher rates of beta-blocker prescribing among their HF patients when compared with physicians who did not attend (78% vs. 58%; p = 0.002), as did physicians who were very confident in managing HF patients when compared with physicians who were not (82% vs. 68%; p = 0.009). Fifty-one of these 69 surveyed physicians (74%) were successfully matched to 287 HF patients for whom beta-blocker prescribing data was available. Physicians with greater self-reported rates of prescribing beta-blockers were significantly more likely to actually prescribe beta-blockers (p = 0.02); however, no other physician characteristics were significantly associated with actual prescribing of beta-blockers among HF patients.
CONCLUSIONS
Physician teaching responsibilities and confidence levels were associated with self-reported beta-blocker prescribing among their HF patients. Educational efforts focused on improving confidence levels in HF care and increasing exposure to teaching may improve beta-blocker presciption in HF patients managed in primary care.
背景
β受体阻滞剂可降低收缩性心力衰竭（HF）患者的死亡率，但初级保健提供者的处方率仍然较低。
目的
研究初级保健医生的特征与收缩性 HF 患者β受体阻滞剂的自我报告和实际处方之间的关系。
设计
横断面调查与补充回顾性图表审查。
参与者
纽约市三家退伍军人事务医疗中心的初级保健提供者。
测量
主要结果是：1）β受体阻滞剂的自我报告处方，2）HF 患者的实际β受体阻滞剂处方。还评估了医生的 HF 实践模式和信心水平以及社会人口统计学和临床特征。
结果
在 101 名医生中，有 69 名（68%）完成了调查，调查了他们对β受体阻滞剂的自我报告处方。与不参加住院病房的医生相比，担任住院病房主治医生的医生报告其 HF 患者β受体阻滞剂的处方率明显更高（78%对 58%；p = 0.002），而对 HF 患者的管理非常有信心的医生与没有信心的医生相比，报告其 HF 患者β受体阻滞剂的处方率也明显更高（82%对 68%；p = 0.009）。在接受调查的 69 名医生中，有 51 名（74%）成功与 287 名 HF 患者匹配，这些患者有β受体阻滞剂处方数据。自我报告的β受体阻滞剂处方率较高的医生实际上更有可能开出β受体阻滞剂（p = 0.02）；但是，其他医生特征与 HF 患者β受体阻滞剂的实际处方无明显相关性。
结论
医生的教学职责和信心水平与他们 HF 患者的自我报告β受体阻滞剂处方有关。以提高 HF 护理信心水平和增加教学接触为重点的教育工作可能会改善初级保健中 HF 患者的β受体阻滞剂处方。
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