Gil-Guillén Vicente, Hermida Enrique, Pita-Fernandez Salvador, Palazon-Bru Antonio, Durazo-Arvizu Ramon, Pallares-Carratala Vicente, Orozco-Beltran Domingo, Carratala-Munuera Concepcion, Lopez-Pineda Adriana, Navarro Jorge
Clinical Medicine Department, Miguel Hernández University, San Juan de Alicante, Alicante, Spain.
Clinical Epidemiology and Biostatistics Unit, Complexo Hospitalario Universitario A Coruña (CHUAC), SERGAS, Universidad de A Coruña, A Coruña, Spain.
Br J Gen Pract. 2015 Jan;65(630):e32-40. doi: 10.3399/bjgp15X683137.
Routine general practice data collection can help identify patients at risk of cardiovascular disease.
To determine whether a training programme for primary care professionals improves the recording of cardiovascular disease risk factors in electronic health records.
A quasi-experimental study without random assignment of professionals. This was an educational intervention study, consisting of an online-classroom 1-year training programme, and carried out in the Valencian community in Spain.
The prevalence rates of recording of cardiovascular factors (recorded every 6 months over a 4-year period) were compared between intervention and control group. Clinical relevance was calculated by absolute risk reduction (ARR), relative risk reduction (RRR), and number of patients needed-to-attend (NNA), to avoid under-recording, with their 95% confidence intervals (CIs). Linear regression models were used for each of the variables.
Of the 941 professionals initially registered, 78.1% completed the programme. The ARR ranged from 1.87% (95% CI = 1.79 to 1.94) in the diagnosis of diabetes to 15.27% (95% CI = 15.14 to 15.40) in the recording of basal blood glucose. The NNA ranged from 7 in blood pressure, cholesterol, and blood glucose recording to 54 in the diagnosis of diabetes. The RRR ranged from 26.7% in the diagnosis of diabetes to 177.1% in the recording of the Systematic Coronary Risk Evaluation (SCORE). The rates of change were greater in the intervention group and the differences were significant for recording of cholesterol (P<0.001), basal blood glucose (P<0.001), smoking (P<0.001), alcohol (P<0.001), microalbuminuria (P = 0.001), abdominal circumference (P<0.001), and SCORE (P<0.001).
The education programme had a beneficial effect at the end of the follow-up that was significant and clinically relevant.
常规全科医疗数据收集有助于识别心血管疾病风险患者。
确定针对基层医疗专业人员的培训计划是否能改善电子健康记录中心血管疾病风险因素的记录情况。
一项未对专业人员进行随机分配的准实验研究。这是一项教育干预研究,包括一个为期1年的在线课堂培训计划,在西班牙巴伦西亚社区开展。
比较干预组和对照组心血管因素(在4年期间每6个月记录一次)的记录患病率。通过绝对风险降低率(ARR)、相对风险降低率(RRR)和需要参与的患者数量(NNA)计算临床相关性,以避免记录不足,并给出其95%置信区间(CI)。对每个变量使用线性回归模型。
最初登记的941名专业人员中,78.1%完成了该计划。ARR范围从糖尿病诊断中的1.87%(95%CI = 1.79至1.94)到基础血糖记录中的15.27%(95%CI = 15.14至15.40)。NNA范围从血压、胆固醇和血糖记录中的7到糖尿病诊断中的54。RRR范围从糖尿病诊断中的26.7%到系统性冠状动脉风险评估(SCORE)记录中的177.1%。干预组的变化率更大,胆固醇记录(P<0.001)、基础血糖(P<0.001)、吸烟(P<0.001)、饮酒(P<0.001)、微量白蛋白尿(P = 0.001)、腹围(P<0.001)和SCORE(P<0.001)的记录差异具有统计学意义。
该教育计划在随访结束时产生了显著且具有临床相关性的有益效果。