Epidemiology and Population Studies Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland.
Kardiol Pol. 2010 Dec;68(12):1332-40.
Despite a decline since 1991, cardiovascular diseases (CVD) are the major burden on public health in Poland.
To assess the impact of the national Programme of Cardiovascular Disease Prevention (PCVDP) on the quality of primary CVD prevention in clinical practice.
Sixty six primary care centres were invited to join the project (2-6 in each province). Half of these centres participated in the PCVDP (in other words, they were 'active' clinics) and the other half was included in the control group. A random sample of 300 patients aged 35-55, free of coronary heart disease, with no history of stroke or peripheral artery disease, and with medical documentation going back at least to 1 January 2005 was selected for the study in each centre. From the total of 3,940 patients in active clinics, 3,162 were judged to be eligible for the study and their medical records were reviewed. All were invited for examination. This was finally attended by 2,314 patients from active clinics and 2,101 from the control group.
Before the introduction of the PCVDP, the percentage of patients with available information on risk factors in medical records was similar in the active and in the control clinics, and varied from more than 40% (hypertension) to less than 5% (weight and waist circumference). After the introduction of the PCVDP, the proportion of subjects with available information on risk factors greatly increased in the clinics which took part in the PCVDP. Knowledge of CVD risk factors was similar in the two studied groups. When asked, about 10% of patients in both groups could not list a single CVD risk factor. Smoking was the most frequently recognised risk factor (named by more than 60% of patients) and diabetes the least (less than 15%). No significant difference was found between the active and control clinics in the frequency of counselling as to smoking, diet, weight reduction or exercise. Only about 40% of smoking patients had received advice on smoking cessation. Counselling on diet had been received by about 40% of patients. Less than 20% of patients had been advised to reduce weight, with about 25% having received advice to increase their physical activity. Control of risk factors was poor and there was no significant difference between the active and control clinics in terms of the proportion of patients who reached prevention targets.
尽管自 1991 年以来有所下降，但心血管疾病（CVD）仍是波兰公共卫生的主要负担。
评估国家心血管疾病预防计划（PCVDP）对临床实践中初级 CVD 预防质量的影响。
邀请了 66 个初级保健中心参加该项目（每个省 2-6 个中心）。其中一半中心参加了 PCVDP（换句话说，它们是“活跃”诊所），另一半被纳入对照组。在每个中心，从 35-55 岁、无冠心病、无中风或外周动脉疾病史且至少有 2005 年 1 月 1 日之前的医疗记录的 300 名患者中随机抽取了 300 名患者进行研究。在 3940 名活跃诊所患者中，共有 3162 名被认为符合研究条件，并对其病历进行了审查。所有患者均被邀请接受检查。最终，有 2314 名来自活跃诊所的患者和 2101 名来自对照组的患者参加了检查。
在引入 PCVDP 之前，活跃诊所和对照组的病历中记录的危险因素信息的百分比相似，从超过 40%（高血压）到不到 5%（体重和腰围）不等。在引入 PCVDP 之后，参与 PCVDP 的诊所中，记录有危险因素信息的患者比例大大增加。两组患者对 CVD 危险因素的了解相似。当被问到这个问题时，两组中约有 10%的患者无法列出一个 CVD 危险因素。吸烟是最常被识别的危险因素（超过 60%的患者提到过），而糖尿病是最不受关注的（不到 15%）。活跃诊所和对照组在吸烟、饮食、减肥或运动方面的咨询频率没有显著差异。只有约 40%的吸烟患者接受了戒烟建议。约有 40%的患者接受了饮食咨询。不到 20%的患者被建议减肥，约 25%的患者被建议增加体力活动。危险因素控制不佳，活跃诊所和对照组在达到预防目标的患者比例方面没有显著差异。
