遵循心血管预防指南：全科医生与执业护士的比较。

Adherence to a guideline on cardiovascular prevention: a comparison between general practitioners and practice nurses.

机构信息

Department of Integrated Care, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, The Netherlands.

出版信息

Int J Nurs Stud. 2011 Jul;48(7):798-807. doi: 10.1016/j.ijnurstu.2010.11.008. Epub 2010 Dec 21.

DOI:10.1016/j.ijnurstu.2010.11.008

PMID:21176903

Abstract

BACKGROUND

Patient non-compliance with prescribed treatment is an important factor in the lack of success in cardiovascular prevention. Another important cause is non-adherence of caregivers to the guidelines. It is not known how doctors and nurses differ in the application of guidelines. Patient compliance to treatment may vary according to the type of caregiver.

OBJECTIVE

To compare adherence to cardiovascular prevention delivered by practice nurses and by general practitioners.

SETTING

Six primary health care centres in the Netherlands (25 general practitioners, six practice nurses).

METHODS

701 high risk patients were included in a randomised trial. Half of the patients received nurse-delivered care and half received care by general practitioners. For 91% of the patients treatment concerned secondary prevention. The Dutch guideline on cardiovascular prevention was used as protocol. A structured self-administered questionnaire was sent by post to patients. Data were extracted from the practice database and the questionnaire.

RESULTS

Intervention was received by 77% of respondents who visited the practice nurse compared to 57% from the general practitioner group (OR = 2.56, p < 0.01). More lifestyle intervention was given by the practice nurse; 46% of patients received at least one lifestyle intervention (weight, diet, exercise, and smoking) compared to 13% in general practitioner group (OR = 3.24, p < 0.001). In addition, after one year more patients from the practice nurse group used cardiovascular drugs (OR = 1.9, p = 0.03). Nurses inquired more frequently about patient compliance to medical treatment (OR = 2.1, p < 0.01). Regarding patient compliance, no statistical difference between study groups in this trial was found.

CONCLUSION

Practice nurses adhered better to the Dutch guideline on cardiovascular prevention than general practitioners did. Lifestyle intervention advice was more frequently given by practice nurses. Improvement of cardiovascular prevention is still necessary. Both caregivers should inquire about patient adherence on a regular basis.

摘要

背景

患者不遵守规定的治疗方案是心血管预防治疗效果不佳的一个重要因素。另一个重要原因是护理人员不遵守指南。目前尚不清楚医生和护士在应用指南方面有何不同。患者对治疗的依从性可能因护理人员的类型而异。

目的

比较执业护士和全科医生在心血管预防方面的依从性。

设置

荷兰六家初级保健中心（25 名全科医生，6 名执业护士）。

方法

701 名高危患者被纳入一项随机试验。一半患者接受护士提供的护理，一半患者接受全科医生的护理。91%的患者接受二级预防治疗。使用荷兰心血管预防指南作为方案。通过邮寄向患者发送了一份结构化的自我管理问卷。从实践数据库和问卷中提取数据。

结果

与全科医生组的 57%相比，到诊所就诊的受访者中有 77%接受了干预措施（OR=2.56，p<0.01）。执业护士提供了更多的生活方式干预；46%的患者接受了至少一种生活方式干预（体重、饮食、运动和吸烟），而全科医生组为 13%（OR=3.24，p<0.001）。此外，一年后，更多来自执业护士组的患者使用了心血管药物（OR=1.9，p=0.03）。护士更频繁地询问患者对药物治疗的依从性（OR=2.1，p<0.01）。在这项试验中，研究组之间在患者依从性方面没有统计学差异。