Jansen Jesse, Bonner Carissa, McKinn Shannon, Irwig Les, Glasziou Paul, Doust Jenny, Teixeira-Pinto Armando, Hayen Andrew, Turner Robin, McCaffery Kirsten
Screening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia.
Screening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
BMJ Open. 2014 May 15;4(5):e004812. doi: 10.1136/bmjopen-2014-004812.
To understand general practitioners' (GPs) use of individual risk factors (blood pressure and cholesterol levels) versus absolute risk in cardiovascular disease (CVD) risk management decision-making.
Randomised experiment. Absolute risk, systolic blood pressure (SBP), cholesterol ratio (total cholesterol/high-density lipoprotein (TC/HDL)) and age were systematically varied in hypothetical cases. High absolute risk was defined as 5-year risk of a cardiovascular event >15%, high blood pressure levels varied between SBP 147 and 179 mm Hg and high cholesterol (TC/HDL ratio) between 6.5 and 7.2 mmol/L.
4 GP conferences in Australia.
144 Australian GPs.
GPs indicated whether they would prescribe cholesterol and/or blood pressure lowering medication. Analyses involved logistic regression.
For patients with high blood pressure: 93% (95% CI 86% to 96%) of high absolute risk patients and 83% (95% CI 76% to 88%) of lower absolute risk patients were prescribed blood pressure medication. Conversely, 30% (95% CI 25% to 36%) of lower blood pressure patients were prescribed blood pressure medication if absolute risk was high and 4% (95% CI 3% to 5%) if lower. 69% of high cholesterol/high absolute risk patients were prescribed cholesterol medication (95% CI 61% to 77%) versus 34% of high cholesterol/lower absolute risk patients (95% CI 28% to 41%). 36% of patients with lower cholesterol (95% CI 30% to 43%) were prescribed cholesterol medication if absolute risk was high versus 10% if lower (95% CI 8% to 13%).
GPs' decision-making was more consistent with the management of individual risk factors than an absolute risk approach, especially when prescribing blood pressure medication. The results suggest medical treatment of lower risk patients (5-year risk of CVD event <15%) with mildly elevated blood pressure or cholesterol levels is likely to occur even when an absolute risk assessment is specifically provided. The results indicate a need for improving uptake of absolute risk guidelines and GP understanding of the rationale for using absolute risk.
了解全科医生（GPs）在心血管疾病（CVD）风险管理决策中使用个体风险因素（血压和胆固醇水平）与绝对风险的情况。
随机实验。在假设病例中系统地改变绝对风险、收缩压（SBP）、胆固醇比率（总胆固醇/高密度脂蛋白（TC/HDL））和年龄。高绝对风险定义为心血管事件的5年风险>15%，高血压水平在SBP 147至179 mmHg之间变化，高胆固醇（TC/HDL比率）在6.5至7.2 mmol/L之间变化。
澳大利亚的4次全科医生会议。
144名澳大利亚全科医生。
全科医生指出他们是否会开具降低胆固醇和/或血压的药物。分析采用逻辑回归。
对于高血压患者：93%（95%CI 86%至96%）的高绝对风险患者和83%（95%CI 76%至88%）的低绝对风险患者被开具了降压药物。相反，血压较低的患者中，如果绝对风险高，30%（95%CI 25%至36%）被开具降压药物，如果绝对风险低，则为4%（95%CI 3%至5%）。69%的高胆固醇/高绝对风险患者被开具了胆固醇药物（95%CI 61%至77%），而高胆固醇/低绝对风险患者为34%（95%CI 28%至41%）。胆固醇水平较低的患者中，如果绝对风险高，36%（95%CI 30%至43%）被开具胆固醇药物，如果绝对风险低，则为10%（95%CI 8%至13%）。
全科医生的决策与个体风险因素管理比与绝对风险方法更一致，尤其是在开具降压药物时。结果表明，即使专门提供了绝对风险评估，血压或胆固醇水平轻度升高的低风险患者（CVD事件的5年风险<15%）也可能接受药物治疗。结果表明需要提高绝对风险指南的采用率以及全科医生对使用绝对风险原理的理解。
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