Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Emerg Med Australas. 2013 Apr;25(2):175-81. doi: 10.1111/1742-6723.12060. Epub 2013 Mar 20.
The present study aimed to determine the prevalence of undiagnosed and undertreated hypercholesterolaemia and hypertension (HT) among ED patients and to evaluate the effects of a formal referral back to the general practitioner (GP) for further management.
This was a cross-sectional study of ED patients with follow up, if indicated. Patients aged ≥35 years, without substantial illness or communication difficulties, were enrolled. Data were collected using a researcher-administered questionnaire, a point-of-care Accutrend® Plus System machine (Roche Diagnostic Australia Pty Ltd, Castle Hill, NSW, Australia) and digital sphygmomanometer. Patients with total cholesterol (TC) ≥6.0 mmol/L and/or BP ≥140/90 were given a referral letter and advised to consult their GP. The investigators made follow-up telephone calls 5 weeks later.
Of 827 presentations, 534 patients were enrolled (mean age 56.7 ± 13.3 years, 300 [56.2%] male). One hundred and eleven patients (20.7%, 95% CI 17.5-24.5) had TC ≥6.0 mmol/L. Patients with/without elevated TC differed significantly (P < 0.05) in regard to age, gender, GP ownership and attendance, and previous screening. Sixty-six patients consulted with their GP. Thirty had their TC levels retested, 18 received dietary/lifestyle advice and four had lipid-lowering medication prescribed or adjusted. Ninety-six patients (18.0%, 95% CI 14.9-21.6) had HT. Whereas 53 consulted their GP, no action was taken in 43 cases. Investigations were ordered for three and nine had antihypertensive medication prescribed or adjusted.
Substantial proportions of ED patients have undiagnosed and undertreated hypercholesterolaemia and/or HT. GP referral initiated interventions for many patients with hypercholesterolaemia, but fewer with HT. The ED has potential as a useful venue for the opportunistic screening of hypercholesterolaemia.
本研究旨在确定 ED 患者中未确诊和治疗不足的高胆固醇血症和高血压（HT）的患病率，并评估将患者正式转介给全科医生（GP）进行进一步管理的效果。
这是一项 ED 患者的横断面研究，如有需要进行随访。招募年龄≥35 岁、无重大疾病或沟通困难的患者。使用研究者管理的问卷、床边 Accutrend® Plus 系统（罗氏诊断澳大利亚有限公司，新南威尔士州卡斯尔山）和数字血压计收集数据。总胆固醇（TC）≥6.0mmol/L 和/或 BP≥140/90 的患者会收到转诊信并建议咨询他们的 GP。研究人员在 5 周后进行随访电话。
在 827 次就诊中，有 534 名患者入组（平均年龄 56.7±13.3 岁，300 名[56.2%]为男性）。111 名患者（20.7%，95%CI 17.5-24.5）TC≥6.0mmol/L。TC 升高/未升高的患者在年龄、性别、GP 所有权和就诊情况以及既往筛查方面存在显著差异（P<0.05）。66 名患者咨询了他们的 GP。30 名患者复查了 TC 水平，18 名患者接受了饮食/生活方式建议，4 名患者接受了降脂药物处方或调整。96 名患者（18.0%，95%CI 14.9-21.6）患有 HT。虽然有 53 名患者咨询了他们的 GP，但 43 名患者没有采取任何行动。为 3 名患者进行了检查，9 名患者开了降压药处方或调整了剂量。
相当比例的 ED 患者患有未确诊和治疗不足的高胆固醇血症和/或 HT。GP 转诊为许多高胆固醇血症患者启动了干预措施，但 HT 患者较少。ED 有可能成为机会性筛查高胆固醇血症的有用场所。
