全科医生对老年人心血管疾病一级预防的决策：一项定性研究。
General Practitioners' Decision Making about Primary Prevention of Cardiovascular Disease in Older Adults: A Qualitative Study.
作者信息
Jansen Jesse, McKinn Shannon, Bonner Carissa, Irwig Les, Doust Jenny, Glasziou Paul, Bell Katy, Naganathan Vasi, McCaffery Kirsten
机构信息
Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia.
出版信息
PLoS One. 2017 Jan 13;12(1):e0170228. doi: 10.1371/journal.pone.0170228. eCollection 2017.
BACKGROUND
Primary cardiovascular disease (CVD) prevention in older people is challenging as they are a diverse group with varying needs, frequent presence of comorbidities, and are more susceptible to treatment harms. Moreover the potential benefits and harms of preventive medication for older people are uncertain. We explored GPs' decision making about primary CVD prevention in patients aged 75 years and older.
METHOD
25 GPs participated in semi-structured interviews in New South Wales, Australia. Transcribed audio-recordings were thematically coded and Framework Analysis was used.
RESULTS
Analysis identified factors that are likely to contribute to variation in the management of CVD risk in older people. Some GPs based CVD prevention on guidelines regardless of patient age. Others tailored management based on factors such as perceptions of prevention in older age, knowledge of limited evidence, comorbidities, polypharmacy, frailty, and life expectancy. GPs were more confident about: 1) medication and lifestyle change for fit/healthy older patients, and 2) stopping or avoiding medication for frail/nursing home patients. Decision making for older patients outside of these categories was less clear.
CONCLUSION
Older patients receive different care depending on their GP's perceptions of ageing and CVD prevention, and their knowledge of available evidence. GPs consider CVD prevention for older patients challenging and would welcome more guidance in this area.
背景
老年人原发性心血管疾病（CVD）的预防具有挑战性，因为他们是一个多样化的群体，需求各异，常伴有多种合并症，且更容易受到治疗伤害。此外，预防性药物对老年人的潜在益处和危害尚不确定。我们探讨了全科医生（GPs）对75岁及以上患者原发性CVD预防的决策。
方法
25名全科医生参与了在澳大利亚新南威尔士州进行的半结构化访谈。对转录的音频记录进行主题编码，并采用框架分析。
结果
分析确定了可能导致老年人CVD风险管理差异的因素。一些全科医生根据指南进行CVD预防，而不考虑患者年龄。另一些则根据诸如对老年人预防的认知、有限证据的了解、合并症、多重用药、虚弱和预期寿命等因素来调整管理。全科医生对以下方面更有信心：1）对健康的老年患者进行药物治疗和生活方式改变，以及2）对体弱/住在养老院的患者停药或避免用药。对于这些类别之外的老年患者，决策则不太明确。
结论
老年患者接受的护理因全科医生对衰老和CVD预防的认知以及他们对现有证据的了解而异。全科医生认为老年患者的CVD预防具有挑战性，并欢迎在这一领域获得更多指导。
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