Kottke T E, Solberg L I, Brekke M L
Cardiovascular Division, Mayo Clinic, Rochester, MN 55905.
Am J Prev Med. 1990;6(2 Suppl):77-83.
The interventions of documented efficacy that have been developed for the treatment of cardiovascular disease risk factors have been neither rapidly nor completely incorporated into clinical practice. This may be due to not recognizing that there is a fundamental conflict between the attributes of the ideal protocol for testing the efficacy of an intervention and the attributes of ideal patient care. For example, when testing an intervention for efficacy, benefit to the subject must be made secondary to the goal of increasing the community's fund of knowledge. When caring for patients, increasing the community's fund of knowledge must be secondary to the goal of benefiting the patient who is receiving care. Therefore, the ideal efficacy-testing program is minimally responsive to the needs of the individual subject; the ideal treatment program is maximally responsive to the needs of the individual patient. A second reason for the slow incorporation of preventive cardiology into patient care is the current lack of a supporting structure. An understanding of the attributes of good patient care and the need for a structure to support preventive cardiology interventions should further the incorporation of preventive cardiology interventions into routine patient care while allowing patient care systems to be scrutinized with efficacy-testing protocols.
已开发出的用于治疗心血管疾病风险因素且有文献记载疗效的干预措施，既没有迅速也没有完全纳入临床实践。这可能是因为没有认识到在测试干预措施疗效的理想方案的属性与理想患者护理的属性之间存在根本冲突。例如，在测试一项干预措施的疗效时，对受试者的益处必须让位于增加社区知识储备这一目标。而在护理患者时，增加社区知识储备必须让位于使接受护理的患者受益这一目标。因此，理想的疗效测试项目对个体受试者的需求反应最小；理想的治疗项目对个体患者的需求反应最大。预防心脏病学缓慢纳入患者护理的第二个原因是目前缺乏支持结构。了解优质患者护理的属性以及支持预防心脏病学干预措施的结构的必要性，应能促进预防心脏病学干预措施纳入常规患者护理，同时允许用疗效测试方案对患者护理系统进行审查。
