NHS 健康检查计划的实施：城市多元文化环境中风险因素记录的基线评估。

Implementation of the NHS Health Checks programme: baseline assessment of risk factor recording in an urban culturally diverse setting.

机构信息

Department of Primary Care and Public Health, Imperial College Faculty of Medicine, St. Dunstan's Road, London, UK.

出版信息

Fam Pract. 2011 Feb;28(1):34-40. doi: 10.1093/fampra/cmq068. Epub 2010 Aug 28.

DOI:10.1093/fampra/cmq068

PMID:20802243

Abstract

BACKGROUND

National Health Service (NHS) Health Checks, a population-wide prevention programme introduced during 2009, aims to measure and manage cardiovascular disease (CVD) risk factors among all persons aged 40-74 years in England. The potential workload implications of the programme for general practice are considerable, particularly in deprived culturally diverse settings.

OBJECTIVE

To examine the baseline levels of CVD risk factor recording in general practices located in Ealing, North West London.

METHODS

Cross-sectional study using data extracted from electronic medical records in 14 general practices between December 2008 and January 2009. The completeness of blood pressure, smoking, body mass index (BMI) and cholesterol recording was examined by practice and patient characteristics.

RESULTS

Recording of blood pressure [85.6% (practice interquartile range = 10.1)] and smoking status [95.8% (2.6)] was very high in practices. Recording of BMI [72.8% (23.4)] and cholesterol [55.6% (25.3)] was considerably lower. There were large differences in recording between practices (range for cholesterol: 33.6-78.0%), though these were largely explained by patient characteristics. In regression analysis, hypertensive patients [adjusted odds ratio (AOR) = 36.3, 95% confidence interval (CI) 21.0-62.9], women [AOR = 2.88 (95% CI 2.64-3.15)] and older patients [AOR = 2.75 (95% CI 2.28-3.32) for 65-74 against 35-44 years of age] had better recording of blood pressure as well as BMI and cholesterol. Recording of blood pressure [AOR = 1.38 (95% CI 1.09-1.75)] and cholesterol [AOR = 1.47 (95% CI 1.30-1.66)] was significantly higher among South Asian patients.

CONCLUSIONS

The workload implications of the NHS Health Checks programme for general practices in England are substantial. There are considerable variations in risk factor recording between practices and between age, gender and ethnic groups.

摘要

背景

国民保健制度（NHS）健康检查是 2009 年推出的一项全民预防计划，旨在测量和管理英格兰所有 40-74 岁人群的心血管疾病（CVD）风险因素。该计划对全科医生的潜在工作量影响很大，尤其是在贫困文化多样性环境中。

目的

检查位于伦敦西北部伊灵的全科医生实践中 CVD 风险因素记录的基线水平。

方法

使用 2008 年 12 月至 2009 年 1 月期间从 14 家全科医生的电子病历中提取的数据进行横断面研究。按实践和患者特征检查血压、吸烟、体重指数（BMI）和胆固醇记录的完整性。

结果

实践中血压记录率非常高[85.6%（实践四分位距=10.1）]和吸烟状况[95.8%（2.6）]。BMI 记录率[72.8%（23.4）]和胆固醇记录率[55.6%（25.3）]要低得多。各实践之间的记录差异很大（胆固醇范围：33.6-78.0%），但这主要可以通过患者特征来解释。在回归分析中，高血压患者[调整后的优势比（AOR）=36.3，95%置信区间（CI）21.0-62.9]、女性[AOR=2.88（95%CI 2.64-3.15）]和老年患者[AOR=2.75（95%CI 2.28-3.32），65-74 岁与 35-44 岁相比]血压、BMI 和胆固醇记录更好。血压记录率[AOR=1.38（95%CI 1.09-1.75）]和胆固醇记录率[AOR=1.47（95%CI 1.30-1.66）]在南亚患者中明显更高。