Programa Nacional de Prevención y Control de Enfermedades Cardiovasculares, Ministerio de Salud, Buenos Aires, Argentina.
Rev Panam Salud Publica. 2013 Apr;33(4):259-66. doi: 10.1590/s1020-49892013000400004.
To identify main barriers to preventing cardiovascular disease and implementing clinical practice guidelines in primary care, to pilot implementation of a tailored enactment of the adapted World Health Organization guidelines to prevent cardiovascular disease, and to assess the impact of the intervention in risk stratification.
A qualitative study was done with decision makers, health professionals, and staff from five primary health care centers, who were interviewed to identify the main barriers. A tailored intervention to apply the guidelines was then designed and implemented. To assess the impact of the intervention on risk factor screening, a before-and-after analysis was performed through a records review of independent samples of patients aged 40 years or older attending each center.
The main barriers identified were lack of awareness of guidelines and lack of knowledge about preventing cardiovascular disease, communication problems within health teams, lack of motivation, and organizational problems. Before (n = 226) and after (n = 234) the intervention, screening of the main risk factors increased: blood pressure measurement from 44.3% to 72.6%, cholesterol measurement from 20.7% to 49.7%, smoking status assessment from 20.4% to 56.1%, diabetes status assessment from 25.5% to 93.6%, and previous vascular event status from 33.2% to 74.3%. Global risk stratification was not done at baseline, compared with 45.1% after the intervention.
The main barriers identified were useful in designing a tailored intervention. Although no clinical outcomes were evaluated, this study shows that the implementation is feasible, with increased risk stratification as a first step at better patient management.
确定预防心血管疾病和实施初级保健临床实践指南的主要障碍，试点实施适应世界卫生组织指南的定制化实施，以预防心血管疾病，并评估干预措施对风险分层的影响。
对来自五家初级保健中心的决策者、卫生专业人员和工作人员进行了定性研究，通过访谈确定主要障碍。然后设计并实施了一项定制的干预措施来应用这些指南。为了评估干预措施对危险因素筛查的影响，通过对每个中心的独立样本患者的记录回顾进行了前后分析。
确定的主要障碍包括缺乏对指南的认识和对预防心血管疾病的知识，卫生团队内部的沟通问题，缺乏动力和组织问题。在干预之前（n=226）和之后（n=234），主要危险因素的筛查增加了：血压测量从 44.3%增加到 72.6%，胆固醇测量从 20.7%增加到 49.7%，吸烟状况评估从 20.4%增加到 56.1%，糖尿病状况评估从 25.5%增加到 93.6%，既往血管事件状况从 33.2%增加到 74.3%。基线时未进行总体风险分层，而干预后则为 45.1%。
确定的主要障碍为定制化干预措施的设计提供了有用信息。尽管没有评估临床结果，但本研究表明实施是可行的，风险分层增加是更好管理患者的第一步。
