Equip d'Atenció Primària Tortosa Oest, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain.
Chair of Family Medicine, Miguel Hernandez University, 03550 San Juan de Alicante, Spain.
Int J Environ Res Public Health. 2018 Jun 11;15(6):1233. doi: 10.3390/ijerph15061233.
To provide a better understanding of the actions taken within health systems and their results, this study aims to assess clinicians’ adherence to clinical practice guidelines regarding recommended treatments in patients with cardiovascular disease in primary care settings, and to determine the associated factors. We conducted an ambispective cohort study in 21 primary care centres in 8 Spanish regions. Patients diagnosed with coronary heart disease, stroke and/or peripheral arterial disease were included. Patients who received the treatment recommended in the European guidelines on cardiovascular disease prevention (CPG’s adherent group) were compared with patients who did not (CPG’s non-adherent group). The outcome variables were cardiovascular hospital admissions, all-cause and cardiovascular mortality during follow-up. Of the 438 participants, 38.6% ( = 169) received the drug therapies recommended in the guidelines. The factors that increased the likelihood of good adherence to CPG’s were being diagnosed with hypertension ( = 0.001), dyslipidaemia ( < 0.001) or diabetes ( = 0.001), and not having a psychiatric disorder ( = 0.005). We found no statistically significant association between good adherence to CPG’s and lower incidence of events ( = 0.853). Clinician adherence to guidelines for secondary prevention of cardiovascular disease was low in the primary care setting.
为了更好地了解卫生系统内的行动及其结果,本研究旨在评估临床医生在初级保健环境中遵循心血管疾病推荐治疗的临床实践指南的情况,并确定相关因素。我们在西班牙 8 个地区的 21 个初级保健中心进行了一项前瞻性队列研究。纳入了诊断为冠心病、中风和/或外周动脉疾病的患者。将接受欧洲心血管疾病预防指南(CPG)推荐治疗的患者(CPG 依从组)与未接受治疗的患者(CPG 不依从组)进行比较。主要结局变量为随访期间的心血管住院、全因和心血管死亡率。在 438 名参与者中,38.6%(n=169)接受了指南推荐的药物治疗。增加 CPG 良好依从性的因素有诊断为高血压(P=0.001)、血脂异常(P<0.001)或糖尿病(P=0.001),以及无精神障碍(P=0.005)。我们没有发现 CPG 良好依从性与事件发生率降低之间存在统计学显著关联(P=0.853)。在初级保健环境中,临床医生对心血管疾病二级预防指南的依从性较低。