Equip d'Atenció Primària Tortosa Oest, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain.
Programa de Doctorat en Medicina, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain.
Int J Environ Res Public Health. 2020 Nov 19;17(22):8590. doi: 10.3390/ijerph17228590.
Cardiovascular diseases (CVD) are the main cause of death worldwide. The control of CVD risk factors, such as dyslipidemia, reduces their mortality rate. Nonetheless, fewer than 50% of patients with ischemic heart disease (IHD) have good cholesterol control. Our objective is to assess whether the level of participation of general practitioners (GPs) in activities to implement a dyslipidemia management guideline, and the characteristics of the patient and physician are associated with cholesterol control in IHD patients. We undertook a quasi-experimental, uncontrolled, before-and-after study of 1151 patients. The intervention was carried out during 2010 and 2011, and consisted of a face-to-face training and online course phase (Phase 1), and another of face-to-face feedback (Phase 2). The main outcome variable was the low-density lipoprotein cholesterol (LDL-C) control, whereby values of <100 mg/dL (2.6 mmol/L) were set as a good level of control, according to the recommendations of the guidelines in force in 2009. After Phase 1, 6.7% more patients demonstrated good cholesterol control. With respect to patient characteristics, being female and being older were found to be risk factors of poor control. Being diabetic and having suffered a stroke were protective factors. Of the GPs' characteristics, being tutor in a teaching center for GP residents and having completed the online course were found to be protective factors. We concluded that cholesterol control in IHD patients was influenced by the type of training activity undertook by physicians during the implementation of the GPC, and patient and physician characteristics. We highlight that if we apply the recent targets of the European guideline, which establish a lower level of LDL-C control, the percentage of good control could be worse than the observed in this study.
心血管疾病 (CVD) 是全球主要的死亡原因。控制 CVD 风险因素，如血脂异常，可以降低死亡率。然而，仅有不到 50%的缺血性心脏病 (IHD) 患者胆固醇控制良好。我们的目的是评估全科医生 (GP) 参与实施血脂异常管理指南的活动水平，以及患者和医生的特征是否与 IHD 患者的胆固醇控制有关。我们进行了一项准实验、非对照、前后对照研究，共纳入了 1151 名患者。干预措施于 2010 年和 2011 年进行，包括面对面培训和在线课程阶段 (第 1 阶段)，以及另一个面对面反馈阶段 (第 2 阶段)。主要结局变量是低密度脂蛋白胆固醇 (LDL-C) 的控制情况，根据 2009 年现行指南的建议，将 <100mg/dL(2.6mmol/L)的 LDL-C 设定为良好控制水平。第 1 阶段后，有 6.7%的患者显示出良好的胆固醇控制。就患者特征而言，女性和年龄较大是控制不良的危险因素。糖尿病和中风史是保护因素。在医生特征方面，担任全科医生住院医师教学中心的导师和完成在线课程被认为是保护因素。我们得出结论，IHD 患者的胆固醇控制受到医生在实施 GPC 期间所进行的培训活动类型以及患者和医生特征的影响。我们强调，如果我们应用欧洲指南的最新目标，即建立更低的 LDL-C 控制水平，那么良好控制的比例可能比本研究中观察到的更差。
