Program in Public Health, Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.
Am J Cardiol. 2012 Feb 15;109(4):521-6. doi: 10.1016/j.amjcard.2011.09.047. Epub 2011 Nov 22.
Primary care site may play an important role in cardiovascular disease prevalence; however, the distribution of risk factors and outcomes across care sites is not known. In this study, a cross-sectional analysis of 21,778 adult participants from the National Health and Nutrition Examination Survey (NHANES; 1999 to 2008) using multivariate logistic regression was conducted to assess the relation between site of usual care and disease prevalence. Patients' self-reported histories of several chronic conditions (hypertension, diabetes, and hypercholesterolemia), awareness of chronic conditions, and associated cardiovascular events (angina, coronary heart disease, cardiovascular disease, myocardial infarction, and stroke) were examined. After adjustment for demographic and health care utilization characteristics, there were no significant differences in the prevalence of diabetes or hypercholesterolemia among patients receiving usual care at private doctors' offices, hospital outpatient clinics, community-based clinics, and emergency rooms (ER). However, participants without usual sources of care and those receiving usual care at ERs had significantly lower awareness of their chronic conditions than participants at other sites. The odds of having a history of each of the adverse cardiovascular events ranged from 2.21 to 4.18 times higher for patients receiving usual care at ERs relative to private doctors' offices. In conclusion, participants who report using ERs as their usual sites of care are disproportionately more likely to have histories of poor cardiovascular outcomes and are more likely to be unaware of having hypertension or hypercholesterolemia. As health care reform takes place and millions more begin seeking care, it is imperative to ensure access to longitudinal care sites designed for continuous disease management.
初级保健机构在心血管疾病的患病率中可能起着重要作用；然而，尚不清楚危险因素和结果在各医疗场所的分布情况。在这项研究中，对来自全国健康和营养检查调查（NHANES；1999 年至 2008 年）的 21778 名成年参与者进行了横断面分析，使用多元逻辑回归评估了常规护理场所与疾病患病率之间的关系。研究调查了患者报告的几种慢性疾病（高血压、糖尿病和高胆固醇血症）的病史、对慢性疾病的认识，以及相关的心血管事件（心绞痛、冠心病、心血管疾病、心肌梗死和中风）。在调整了人口统计学和医疗保健利用特征后，在私人医生办公室、医院门诊、社区诊所和急诊室（ER）接受常规护理的患者中，糖尿病或高胆固醇血症的患病率没有显著差异。然而，没有常规医疗来源的参与者和在 ER 接受常规护理的参与者对其慢性疾病的认识明显低于其他场所的参与者。与在私人医生办公室接受常规护理的参与者相比，在 ER 接受常规护理的参与者发生每种不良心血管事件的历史的几率从 2.21 倍到 4.18 倍不等。总之，报告使用 ER 作为其常规护理场所的参与者更有可能有不良心血管结局的病史，并且更有可能不知道自己患有高血压或高胆固醇血症。随着医疗改革的进行，数以百万计的人开始寻求医疗保健，确保获得设计用于持续疾病管理的纵向护理场所至关重要。
