Department of Neurology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu 610041, Sichuan Province, China.
J Clin Neurosci. 2013 Oct;20(10):1427-32. doi: 10.1016/j.jocn.2013.01.012. Epub 2013 Aug 9.
Despite the benefits in reducing the risk of stroke, primary prevention is not well translated into practice. We sought to evaluate patient compliance with guidelines and the cost of primary stroke prevention in southwest China. We consecutively enrolled 305 patients with headaches and/or dizziness who were at high risk of stroke from our hospital. We retrospectively obtained their information, including the extent of their knowledge of stroke risk factors, adherence to guidelines, medications taken, and costs of primary prevention for stroke within the past year. Only 45.9% of patients had any knowledge of primary prevention, and only 17.0% had completely followed guidelines. Moreover, 79.0% of the patients were using medications, but only 39.3% took their medication as recommended. In patients who took medication, 89.6% were prescribed by physicians. The annual costs of primary prevention were estimated to be US$517.8 per capita, which included direct medical costs (US$435.4), direct non-medical costs (US$18.1), and indirect costs (US$64.3). Costs in the hypertension group were less than those reported by a similar international study. Although our population sample may not be representative of the population at high risk of stroke in China, it is appropriate for the evaluation of our primary prevention system. Primary prevention for stroke in southwest China is very challenging, with few medical resource investments. There is a current urgency to improve patient knowledge of primary prevention, which would bridge the gaps between guidelines and practice and increase medical resource investments.
尽管降低中风风险有很多好处，但初级预防措施并未很好地转化为实践。我们旨在评估中国西南地区患者对指南的依从性和初级中风预防的成本。我们连续纳入了 305 名来自我院的有中风高危因素的头痛和/或头晕患者。我们回顾性地获取了他们的信息，包括对中风危险因素的了解程度、对指南的依从性、服用的药物以及过去一年中风初级预防的费用。仅有 45.9%的患者对初级预防有任何了解，仅有 17.0%的患者完全遵循了指南。此外，79.0%的患者在服用药物，但只有 39.3%的患者按推荐剂量服用。在服用药物的患者中，89.6%是由医生开具处方。估计每人每年的初级预防费用为 517.8 美元，包括直接医疗费用（435.4 美元）、直接非医疗费用（18.1 美元）和间接费用（64.3 美元）。高血压组的费用低于类似的国际研究报道的费用。尽管我们的人群样本可能不能代表中国有中风高危因素的人群，但它适合评估我们的初级预防系统。中国西南地区的中风初级预防面临很大的挑战，医疗资源投入较少。目前迫切需要提高患者对初级预防的认识，缩小指南与实践之间的差距，并增加医疗资源投入。
