Wong In, Tse See Fai, Kwok Chau Sha
Health Bureau, Macau SAR Government, Macau, China.
Fam Med Community Health. 2020 Feb 24;8(1):e000222. doi: 10.1136/fmch-2019-000222. eCollection 2020.
The objective of this study was to test the effectiveness of an audit programme for dyslipidaemia management in a primary care setting in Macau.
A quality improvement study based on an evaluation of a before-after intervention trial was conducted in 2017-2018. Interventions comprising feedback from an audit, general practitioner (GP) training via interactive workshops and one-on-one case discussions were implemented. The primary outcome measure was the proportion of patients with reasonable management of dyslipidaemia, and the secondary outcome measure was the proportion of patients with low-density lipoprotein cholesterol (LDL-C) meeting the target recommended by the Adult Treatment Panel III guidelines.
This study was conducted at the Sao Lourenco Health Center, one of the health centres in the Macau primary care system; this centre provides primary care services to one-tenth of the residents of Macau.
All GPs who worked in the Sao Lourenco Health Center participated in the study. We systematically reviewed 100 patient records from each participating physician's patient list. In total, 1200 and 1100 patient records were reviewed before and after the intervention, respectively.
At baseline, 390 (43.5%) patients were eligible for statin therapy, while 411 (47.7%) patients were eligible for statin therapy in the reaudit group (p=0.08). After intervention, the proportion of patients with reasonable management of dyslipidaemia increased from 83.9% to 88.5% (p=0.005), and the proportion of eligible patients with LDL-C levels meeting the target increased from 55.1% to 65% (p=0.004).
The audits and feedback significantly improved dyslipidaemia management in the Macau primary care setting.
本研究旨在测试澳门基层医疗环境中血脂异常管理审核计划的有效性。
2017年至2018年进行了一项基于前后干预试验评估的质量改进研究。实施了包括审核反馈、通过互动研讨会进行全科医生培训以及一对一病例讨论在内的干预措施。主要结局指标是血脂异常管理合理的患者比例，次要结局指标是低密度脂蛋白胆固醇（LDL-C）达到成人治疗小组III指南推荐目标的患者比例。
本研究在澳门基层医疗系统中的健康中心之一圣若伦索健康中心进行；该中心为澳门十分之一的居民提供基层医疗服务。
所有在圣若伦索健康中心工作的全科医生参与了本研究。我们系统地审查了每位参与医生患者名单中的100份患者记录。干预前后分别共审查了1200份和1100份患者记录。
基线时，390名（43.5%）患者符合他汀类药物治疗条件，而重新审核组中有411名（47.7%）患者符合他汀类药物治疗条件（p = 0.08）。干预后，血脂异常管理合理的患者比例从83.9%增至88.5%（p = 0.005），符合条件且LDL-C水平达标的患者比例从55.1%增至65%（p = 0.004）。
审核和反馈显著改善了澳门基层医疗环境中的血脂异常管理。
