为临床医生提供患者的 10 年心血管风险可改善其他汀类药物的开具情况：使用临床病例进行的真实验。
Providing clinicians with a patient's 10-year cardiovascular risk improves their statin prescribing: a true experiment using clinical vignettes.
机构信息
Division of General Internal Medicine, University of Michigan Medical School & VA Ann Arbor Healthcare System, 3119 Taubman Center, 1500 East Medical Center Drive, 48109-5604 Ann Arbor, MI, USA.
出版信息
BMC Cardiovasc Disord. 2013 Oct 22;13:90. doi: 10.1186/1471-2261-13-90.
BACKGROUND
Statins are effective for primary prevention of cardiovascular (CV) disease, the leading cause of death in the world. Multinational guidelines emphasize CV risk as an important factor for optimal statin prescribing. However, it's not clear how primary care providers (PCPs) use this information. The objective of this study was to determine how primary care providers use information about global CV risk for primary prevention of CV disease.
METHODS
A double-blinded, randomized experiment using clinical vignettes mailed to office-based PCPs in the United States who were identified through the American Medical Association Physician Masterfile in June 2012. PCPs in the control group received clinical vignettes with all information on the risk factors needed to calculate CV risk. The experimental group received the same vignettes in addition to the subject's 10-year calculated CV risk (Framingham risk score). The primary study outcome was the decision to prescribe a statin.
RESULTS
Providing calculated CV risk to providers increased statin prescribing in the two high-risk cases (CV risk > 20%) by 32 percentage points (41% v. 73%; 95% CI = 23-40, p <0.001; relative risk [RR] = 1.78) and 16 percentage points (12% v. 27%, 95% CI 8.5-22.5%, p <0.001; RR = 2.25), and decreased statin prescribing in the lowest risk case (CV risk = 2% risk) by 9 percentage points [95% CI = 1.00-16.7%, p = 0.003, RR = 0.88]. Fewer than 20% of participants in each group reported routinely calculating 10-year CV risk in their patients.
CONCLUSIONS
Providers do not routinely calculate 10-year CV risk for their patients. In this vignette experiment, PCPs undertreated low LDL, high CV risk patients. Giving providers a patient's calculated CV risk improved statin prescribing. Providing PCPs with accurate estimates of patient CV risk at the point of service has the potential to improve the efficiency of statin prescribing.
背景
他汀类药物对心血管疾病（CV）的一级预防有效，CV 疾病是世界上主要的死亡原因。多国指南强调 CV 风险是他汀类药物最佳处方的重要因素。然而，目前尚不清楚初级保健提供者（PCP）如何使用这些信息。本研究旨在确定初级保健提供者如何使用全球 CV 风险信息来预防 CV 疾病。
方法
这是一项使用临床病例报告于 2012 年 6 月通过美国医学协会医师名录邮寄给美国基层医疗机构的 PCP 进行的双盲、随机实验。对照组的 PCP 收到了需要计算 CV 风险的所有危险因素信息的临床病例报告。实验组收到了相同的病例报告，以及受试者的 10 年计算 CV 风险（弗雷明汉风险评分）。主要研究结果是开具他汀类药物的决定。
结果
向提供者提供计算出的 CV 风险增加了两种高风险情况下（CV 风险>20%）开具他汀类药物的比例，增加了 32 个百分点（41%比 73%；95%CI=23-40，p<0.001；相对风险[RR]=1.78）和 16 个百分点（12%比 27%；95%CI=8.5-22.5%，p<0.001；RR=2.25），而在最低风险情况下（CV 风险=2%风险）减少了 9 个百分点[95%CI=1.00-16.7%，p=0.003，RR=0.88]。每个组中不到 20%的参与者报告他们在患者中常规计算 10 年 CV 风险。
结论
提供者没有常规为患者计算 10 年 CV 风险。在这个病例报告实验中，PCP 对 LDL 低、CV 风险高的患者治疗不足。向提供者提供患者的计算 CV 风险改善了他汀类药物的处方。在服务点为 PCP 提供患者 CV 风险的准确估计有可能提高他汀类药物的处方效率。
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