C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.
BMC Cardiovasc Disord. 2012 Sep 12;12:74. doi: 10.1186/1471-2261-12-74.
Primary care plays a key role in the prevention and management of cardiovascular disease (CVD). We examined primary care practice adherence to recommended care guidelines associated with the prevention and management of CVD for high risk patients.
We conducted a secondary analysis of cross-sectional baseline data collected from 84 primary care practices participating in a large quality improvement initiative in Eastern Ontario from 2008 to 2010. We collected medical chart data from 4,931 patients who either had, or were at high risk of developing CVD to study adherence rates to recommended guidelines for CVD care and to examine the proportion of patients at target for clinical markers such as blood pressure, lipid levels and hemoglobin A1c.
Adherence to preventive care recommendations was poor. Less than 10% of high risk patients received a waistline measurement, half of the smokers received cessation advice, and 7.7% were referred to a smoking cessation program. Gaps in care exist for diabetes and kidney disease as 54.9% of patients with diabetes received recommended hemoglobin-A1c screenings, and only 55.8% received an albumin excretion test. Adherence rates to recommended guidelines for coronary artery disease, hypertension, and dyslipidemia were high (>75%); however <50% of patients were at target for blood pressure or LDL-cholesterol levels (37.1% and 49.7% respectively), and only 59.3% of patients with diabetes were at target for hemoglobin-A1c.
There remain significant opportunities for primary care providers to engage high risk patients in prevention activities such as weight management and smoking cessation. Despite high adherence rates for hypertension, dyslipidemia, and coronary artery disease, a significant proportion of patients failed to meet treatment targets, highlighting the complexity of caring for people with multiple chronic conditions.
初级保健在心血管疾病（CVD）的预防和管理中发挥着关键作用。我们研究了初级保健实践对与高危患者 CVD 预防和管理相关的推荐护理指南的遵循情况。
我们对 2008 年至 2010 年期间在安大略省东部参与一项大型质量改进计划的 84 个初级保健实践进行的横断面基线数据进行了二次分析。我们从 4931 名患有或有发展为 CVD 风险的患者的医疗记录中收集数据，以研究 CVD 护理推荐指南的遵循率，并检查血压、血脂水平和血红蛋白 A1c 等临床指标达到目标的患者比例。
预防保健建议的遵循情况较差。不到 10%的高危患者接受腰围测量，一半的吸烟者接受戒烟建议，只有 7.7%的人被转介到戒烟计划。糖尿病和肾病的护理存在差距，因为 54.9%的糖尿病患者接受了推荐的血红蛋白 A1c 筛查，只有 55.8%接受了白蛋白排泄试验。建议的冠状动脉疾病、高血压和血脂异常指南的遵循率很高（>75%）；然而，只有不到 50%的患者血压或 LDL 胆固醇水平达标（分别为 37.1%和 49.7%），只有 59.3%的糖尿病患者的血红蛋白 A1c 达标。
初级保健提供者仍有很大机会让高危患者参与体重管理和戒烟等预防活动。尽管高血压、血脂异常和冠状动脉疾病的遵循率较高，但仍有相当一部分患者未能达到治疗目标，突出了患有多种慢性疾病患者的护理复杂性。
