Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands.
BMC Fam Pract. 2011 Jul 6;12:69. doi: 10.1186/1471-2296-12-69.
Considering the scarcity of health care resources and the high costs associated with cardiovascular diseases, we investigated the spending on cardiovascular primary preventive activities and the prescribing behaviour of primary preventive cardiovascular medication (PPCM) in Dutch family practices (FPs).
A mixed methods design was used, which consisted of a questionnaire (n = 80 FPs), video recordings of hypertension- or cholesterol-related general practitioner visits (n = 56), and the database of Netherlands Information Network of General Practice (n = 45 FPs; n = 157,137 patients). The questionnaire and video recordings were used to determine the average frequency and time spent on cardiovascular primary preventive activities per FP respectively. Taking into account the annual income and full time equivalents of general practitioners, health care assistants, and practice nurses as well as the practice costs, the total spending on cardiovascular primary preventive activities in Dutch FPs was calculated. The database of Netherlands Information Network of General Practice was used to determine the prescribing behaviour in Dutch FPs by conducting multilevel regression models and adjusting for patient and practice characteristics.
Total expenditure on cardiovascular primary preventive activities in FPs in 2009 was €38.8 million (€2.35 per capita), of which 47% was spent on blood pressure measurements, 26% on cardiovascular risk profiling, and 11% on lifestyle counselling. Fifteen percent (€11 per capita) of all cardiovascular medication prescribed in FPs was a PPCM. FPs differed greatly on prescription of PPCM (odds ratio of 3.1).
Total costs of cardiovascular primary preventive activities in FPs such as blood pressure measurements and lifestyle counselling are relatively low compared to the costs of PPCM. There is considerable heterogeneity in prescribing behaviour of PPCM between FPs. Further research is needed to determine whether such large differences in prescription rates are justified. Striving for an optimal use of cardiovascular primary preventive activities might lead to similar health outcomes, but may achieve important cost savings.
考虑到医疗保健资源的稀缺性以及心血管疾病相关成本高昂，我们调查了荷兰家庭医生（FP）开展心血管一级预防活动的支出情况以及开具心血管一级预防药物（PPCM）的情况。
采用混合方法设计，包括问卷调查（n=80 个 FP）、高血压或胆固醇相关全科医生就诊的视频记录（n=56）以及荷兰全科医生信息网络数据库（n=45 个 FP；n=157137 名患者）。问卷调查和视频记录分别用于确定每个 FP 进行心血管一级预防活动的平均频率和时间。考虑到全科医生、保健助理和护士的年收入和全职当量以及诊所成本，计算了荷兰 FP 开展心血管一级预防活动的总支出。利用荷兰全科医生信息网络数据库，通过开展多水平回归模型并调整患者和诊所特征，确定荷兰 FP 的处方行为。
2009 年 FP 开展心血管一级预防活动的总支出为 3880 万欧元（人均 2.35 欧元），其中 47%用于血压测量，26%用于心血管风险评估，11%用于生活方式咨询。FP 开具的所有心血管药物中，有 15%（人均 11 欧元）为 PPCM。FP 之间在开具 PPCM 方面存在较大差异（比值比为 3.1）。
FP 开展的心血管一级预防活动（如血压测量和生活方式咨询）的总成本与 PPCM 的成本相比相对较低。FP 之间在开具 PPCM 方面存在较大的处方行为差异。需要进一步研究以确定如此大的处方率差异是否合理。努力优化心血管一级预防活动的使用可能会带来类似的健康结果，但可能会节省大量成本。
