Carratala-Munuera Concepción, Gil-Guillen Vicente F, Orozco-Beltran Domingo, Maiques-Galan Antonio, Lago-Deibe Fernando, Lobos-Bejarano Jose M, Brotons-Cuixart Carlos, Martin-Rioboo Enrique, Alvarez-Guisasola Fernando, Lopez-Pineda Adriana
Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante,
Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante.
Fam Pract. 2015 Dec;32(6):672-80. doi: 10.1093/fampra/cmv038. Epub 2015 Jun 18.
To assess the barriers that make it difficult for the health care professionals (physicians, nurses and health care managers) to achieve a better control for dyslipidemia in Spain.
The study has an observational design and was performed using the modified Delphi technique. One hundred and forty-nine panel members from medicine, nursing and health care management fields and from different Spanish regions were selected randomly and were invited to participate. Individual and anonymous opinions were asked by answering a 42-items questionnaire via e-mail (two rounds were done). Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the three groups (Kappa index and McNemar chi-square).
Response rate: 81%. The agreement index was 33.3 (95% CI: 18.9-47.7). Regarding the non-compliance with therapy, it improves with patient education degree in dyslipidemia, patient motivation, the agreement on decisions with the patient and with the use of cardiovascular risk measure and it gets worse with lack of information on the objectives to achieve. Clinical inertia improves with professional's motivation, cardiovascular risk calculation, training on objectives and the use of indicators and it gets worse with lack of treatment goals.
Different perceptions and attitudes between medicine, nursing and health care management were found. An agreement in interventions in non-compliance and clinical inertia to improve dyslipidemia control was reached.
评估阻碍西班牙医疗保健专业人员（医生、护士和医疗保健管理人员）更好地控制血脂异常的因素。
本研究采用观察性设计，并运用改良的德尔菲技术进行。随机选取了来自西班牙不同地区医学、护理和医疗保健管理领域的149名小组成员，并邀请他们参与。通过电子邮件回答一份包含42个条目的问卷来征求个人的匿名意见（共进行两轮）。使用集中趋势和离散度测量方法评估一致程度。我们分析了三组之间的共性/差异（卡帕指数和麦克内马尔卡方检验）。
回复率：81%。一致指数为33.3（95%置信区间：18.9 - 47.7）。关于治疗不依从问题，随着血脂异常患者教育程度的提高、患者积极性的提升、与患者在决策上的一致性以及心血管风险测量方法的使用，情况会有所改善；而随着对要实现的目标缺乏信息，情况会恶化。临床惰性随着专业人员的积极性、心血管风险计算、目标培训以及指标的使用而改善；随着缺乏治疗目标，情况会恶化。
发现医学、护理和医疗保健管理之间存在不同的认知和态度。就改善血脂异常控制的不依从和临床惰性干预措施达成了一致意见。
