Rosell-Murphy Magdalena, Rodriguez-Blanco Teresa, Morán Julio, Pons-Vigués Mariona, Elorza-Ricart Josep M, Rodríguez Jordi, Pareja Clara, Nuin María Ángeles, Bolíbar Bonaventura
Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain.
Equip d'Atenció Primària Serraparera. Institut Català de la Salut, Cerdanyola del Vallès, Spain.
BMC Public Health. 2015 May 7;15:473. doi: 10.1186/s12889-015-1767-5.
Despite evidence of the benefits of prevention activities, studies have reported only partial integration and great variability of screening in daily clinical practice. The study objectives were: 1) To describe Primary Health Care (PHC) screening for arterial hypertension, dyslipidaemia, obesity, tobacco use, and excessive alcohol consumption in 2008 in 2 regions of Spain, based on electronic health records, and 2) To assess and quantify variability in screening, and identify factors (of patient, general practitioners and PHC team) associated with being screened, that are common throughout the PHC population.
Multicentre, cross-sectional study of individuals aged ≥ 16 years (N = 468,940) who visited the 426 general practitioners (GPs) in 44 PHC teams in Catalonia and Navarre in 2008.
screening for hypertension, dyslipidaemia, obesity, tobacco use, and excessive alcohol consumption. Other variables were considered at the individual (sociodemographics, visits, health problems), GP and PHC team (region among others). Individual and contextual factors associated with the odds of being screened and the variance attributable to each level were identified using the SAS PROC GLIMMIX macro.
The most prevalent screenings were for dyslipidaemia (64.4%) and hypertension (50.8%); the least prevalent was tobacco use (36.6%). Overall, the odds of being screened were higher for women, older patients, those with more comorbidities, more cardiovascular risk factors, and more frequent office visits, and those assigned to a female GP, a GP with a lower patient load, or a PHC team with a lower percentage of patients older than 65 years. On average, individuals in Navarre were less likely to be screened than those in Catalonia. Hypertension and dyslipidaemia screenings had the least unexplained variability between PHC teams and GPs, respectively, after adjusting for individual and contextual factors.
Of the studied screenings, those for obesity, tobacco, and alcohol use were the least prevalent. Attention to screening, especially for tobacco and alcohol, can be greatly improved in the PHC setting.
尽管有证据表明预防活动有益，但研究报告称，在日常临床实践中，筛查工作仅部分得到整合，且差异很大。研究目标如下：1）基于电子健康记录，描述2008年西班牙两个地区初级卫生保健（PHC）对动脉高血压、血脂异常、肥胖、吸烟和过度饮酒的筛查情况；2）评估并量化筛查的差异，识别在整个初级卫生保健人群中普遍存在的、与接受筛查相关的因素（患者、全科医生和初级卫生保健团队方面的因素）。
对2008年在加泰罗尼亚和纳瓦拉的44个初级卫生保健团队中就诊的426名全科医生（GP）的年龄≥16岁的个体（N = 468,940）进行多中心横断面研究。
筛查项目中最普遍的是血脂异常（64.4%）和高血压（50.8%）；最不普遍的是吸烟（36.6%）。总体而言，女性、老年患者、合并症更多、心血管危险因素更多、就诊更频繁的患者，以及分配到女全科医生、患者量较低的全科医生或65岁以上患者比例较低的初级卫生保健团队的患者，接受筛查的几率更高。平均而言，纳瓦拉的个体接受筛查的可能性低于加泰罗尼亚的个体。在调整个体和背景因素后，初级卫生保健团队和全科医生之间，高血压和血脂异常筛查的 unexplained variability 分别最小。
在所研究的筛查项目中，肥胖、吸烟和饮酒方面的筛查最不普遍。在初级卫生保健环境中，对筛查的关注，尤其是对吸烟和饮酒的筛查，可大幅改善。
