Buono Nicola, Petrazzuoli Ferdinando, D'Addio Filippo, Farinaro Carmine, Soler Jean Karl
National Italian Society of Medical Education In General Practice, Caserta, Italy.
Rural Remote Health. 2013 Oct-Dec;13(4):2225. Epub 2013 Dec 1.
There has not yet been an audit of achievement rates of therapeutic targets for cholesterol management in the rural Italian primary care setting. The purpose of this study was to measure the percentage of patients with hypercholesterolaemia in a rural primary care setting in southern Italy, classify their risk category and measure the proportions of those patients who achieved optimal cholesterol levels according to the Adult Treatment Panel III guidelines.
The audit was completed using records from 1 January 2005 to 31 December 2007. An electronic search key was entered into the electronic clinical records of 10 family doctors in a rural area of southern Italy for subjects with a diagnosis of or being treated for hypercholesterolaemia. A total of 194 hypercholesterolaemic patients were randomly selected from a cohort of patients registered with these family doctors. The low density lipoprotein cholesterol (LDL-C) target level was 100 mg/dL (2.6 mmol/L) in patients with existing cardiovascular disease, 130 mg/dL (3.3 mmol/L) for patients with ≥2 risk factors, and 160 mg/dL (4.1 mmol/L) for all other patients. The results regarding the efficacy of the therapy were categorised as follows: (1) on target, LDL-C lower or equal to levels of affiliated class; (2) poor control, 1-30 mg/dL (0.03-0.78 mmol/L) above the target level of LDL-C; (3) very poor control, ≥31 mg/dL (≥0.8 mmol/L) above the LDL-C target level.
The average age of the hypercholesterolaemic patients included in the study was 62.0 ± 9.0 years; 55% were males, 30% were smokers, 71.3% suffered from hypertension, 46.3% had diabetes, 39.9% were obese and 31.9% had a family history of coronary disease. There were 114 subjects in Class I (personal history of coronary disease, cardiovascular risk ≥ 20, diabetes mellitus) LDL-C target level. Of these patients, 24.6% were at target, 30.7% had poor control and 44.7% had very poor control. A total of 42.3% of the subjects examined with the score system adopted by the Italian Heart Project showed levels of cardiovascular risk between 5% and 19% and were not eligible for a free prescription of lipid-lowering drugs.
These data suggest that cholesterol management in this rural area is not always optimal in patients with high cardiovascular risk. Italian healthcare regulation seems to be a barrier to drug prescription and it may influence optimal LDL-C control.
意大利农村基层医疗环境中胆固醇管理治疗目标达成率尚未得到审计。本研究的目的是测量意大利南部农村基层医疗环境中高胆固醇血症患者的百分比，对他们的风险类别进行分类，并根据成人治疗小组III指南测量那些达到最佳胆固醇水平的患者比例。
审计使用了2005年1月1日至2007年12月31日的记录。在意大利南部农村地区的10名家庭医生的电子临床记录中输入电子搜索关键词，以查找诊断为高胆固醇血症或正在接受高胆固醇血症治疗的患者。从这些家庭医生登记的患者队列中随机选择了194名高胆固醇血症患者。对于已有心血管疾病的患者，低密度脂蛋白胆固醇（LDL-C）目标水平为100mg/dL（2.6mmol/L）；对于有≥2个危险因素的患者，目标水平为130mg/dL（3.3mmol/L）；对于所有其他患者，目标水平为160mg/dL（4.1mmol/L）。关于治疗效果的结果分类如下：（1）达标，LDL-C低于或等于所属类别的水平；（2）控制不佳，高于LDL-C目标水平1-30mg/dL（0.03-0.78mmol/L）；（3）控制极差，高于LDL-C目标水平≥31mg/dL（≥0.8mmol/L）。
纳入研究的高胆固醇血症患者的平均年龄为62.0±9.0岁；55%为男性，30%为吸烟者，71.3%患有高血压，46.3%患有糖尿病，39.9%肥胖，31.9%有冠心病家族史。I类（冠心病个人史、心血管风险≥20、糖尿病）有114名受试者有LDL-C目标水平。在这些患者中，24.6%达标，30.7%控制不佳，44.7%控制极差。采用意大利心脏项目所采用的评分系统检查的受试者中，共有42.3%的人心血管风险水平在5%至19%之间，没有资格免费获得降脂药物处方。
这些数据表明，在这个农村地区，心血管风险高的患者的胆固醇管理并不总是最佳的。意大利的医疗保健规定似乎是药物处方的一个障碍，并且可能影响LDL-C的最佳控制。
