Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, Washington, USA.
Am J Cardiovasc Drugs. 2010;10(2):105-8. doi: 10.2165/11532820-000000000-00000.
Elevation of serum cholesterol, or hyperlipidemia, is recognized as one of the major modifiable risk factors in the development of atherosclerosis and cardiovascular disease. On a US population basis, there has been a downward trend in total- and LDL-cholesterol levels, and an increase in cholesterol screening. Nevertheless, previous research suggests that there remain racial/ethnic disparities in the access to and quality of care for hyperlipidemia.
The aim of this study was to examine the extent of racial/ethnic disparities in the provision of pharmacotherapy, cholesterol screening and diet/nutrition or exercise counseling during US office-based physician-patient encounters (visits) by patients with hyperlipidemia.
We examined data from the 2005 US National Ambulatory Medical Care Survey for office-based visits for hyperlipidemia for patients aged > or =20 years in terms of prescribing for hyperlipidemia, and the ordering/provision of cholesterol testing, diet/nutrition counseling, and exercise counseling.
Use of pharmacotherapy for hyperlipidemia varied by ethnicity/race (chi2, p < 0.05). Physician-ordered/provided cholesterol screening occurred in 44.2% of all office-based visits; 46.5% for Whites, 35.4% for Blacks, and 30.3% for Hispanics (chi2, p < 0.05). Diet/nutrition counseling was ordered/provided in 39.7% of office-based visits; 40.4% for Whites, 32.6% for Blacks, and 39.0% for Hispanics (chi2, p < 0.05). Exercise counseling was ordered/provided in 32.1% of office-based visits; 32.7% for Whites, 27.2% for Blacks, and 30.6% for Hispanics (chi2, p < 0.05).
These findings reveal a disparity in use of pharmacotherapy for hyperlipidemia, physician-ordered/provided cholesterol screening, diet/nutrition counseling, and exercise counseling by ethnicity/race. Further research is required to discern, in greater detail, reasons for the observed differences reported, and to ensure equitable access to established standards of care.
血清胆固醇升高，即高血脂，被认为是动脉粥样硬化和心血管疾病发展的主要可改变的危险因素之一。在美国人群中，总胆固醇和 LDL 胆固醇水平呈下降趋势，胆固醇筛查也有所增加。然而，先前的研究表明，在获得和提供高血脂治疗方面仍然存在种族/民族差异。
本研究旨在检查美国门诊医生与高血脂患者的医患就诊过程中，在提供药物治疗、胆固醇筛查以及饮食/营养或运动咨询方面，种族/民族差异的程度。
我们检查了 2005 年美国全国门诊医疗保健调查中年龄≥20 岁的高血脂患者门诊就诊的数据，根据处方治疗高血脂、开处方/提供胆固醇检测、饮食/营养咨询以及运动咨询，评估药物治疗高血脂、胆固醇检测、饮食/营养咨询和运动咨询的使用情况。
高血脂的药物治疗使用情况因种族/民族而异（卡方检验，p<0.05）。在所有门诊就诊中，医生开处方/提供的胆固醇筛查有 44.2%；白人占 46.5%，黑人占 35.4%，西班牙裔占 30.3%（卡方检验，p<0.05）。饮食/营养咨询在 39.7%的门诊就诊中被开处方/提供；白人占 40.4%，黑人占 32.6%，西班牙裔占 39.0%（卡方检验，p<0.05）。运动咨询在 32.1%的门诊就诊中被开处方/提供；白人占 32.7%，黑人占 27.2%，西班牙裔占 30.6%（卡方检验，p<0.05）。
这些发现揭示了在使用药物治疗高血脂、医生开处方/提供胆固醇筛查、饮食/营养咨询以及运动咨询方面，种族/民族差异的存在。需要进一步研究，更详细地了解报告的差异的原因，并确保公平获得既定的护理标准。
