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儿科医生和家庭医学临床医生在小儿胆固醇筛查建议方面的实践和态度存在差异。

Practices and Attitudes Regarding Pediatric Cholesterol Screening Recommendations Differ Between Pediatricians and Family Medicine Clinicians.

机构信息

Department of Pediatrics, Division of Pediatric Cardiology, University of Wisconsin School of Medicine and Public Health, CSC H6/534 MC 4108, 600 Highland Ave., Madison, WI, 53792, USA.

Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of Wisconsin School of Medicine and Public Health, 2870 University Ave. Ste. 200 MC 9010, Madison, WI, 53705, USA.

出版信息

Pediatr Cardiol. 2022 Mar;43(3):631-635. doi: 10.1007/s00246-021-02767-y. Epub 2021 Nov 2.

Abstract

Pediatricians had higher rates of ordering pediatric cholesterol screening than family medicine (FM) clinicians. This study aims to compare knowledge, attitude, and practices of clinicians' pediatric cholesterol screening practices and attitudes between these two specialties. A 14-item electronic survey using Likert scales was sent to all clinicians in the institution's Departments of Pediatrics and FM between 2018 and 2019. Chi-square and t-tests were used to compare pediatricians and FM clinicians. 22 clinicians from Pediatrics and 111 from FM completed the survey. Compared to FM clinicians, pediatricians were more familiar with the National Heart, Lung, and Blood Institute guidelines, which are more vigorous in their recommendation of universal cholesterol screening. Pediatricians reported being more supportive of universal cholesterol screening in children (p < 0.05). In practice, pediatricians reported screening almost two thirds (64.8%) of eligible patients during the past year, while FM clinicians reported screening approximately one third (34.1%) of eligible patients (p < 0.001). Pediatricians were more likely to screen based on patient-specific risk factors and their practice decisions were more heavily influenced by published guidelines, institutional education, availability of non-fasting blood to be used for screening, and the availability of an institutional pediatric lipid clinic (p < 0.05). The differences in knowledge, attitudes, and practices of cholesterol screening may contribute to different screening rates among clinicians from FM and pediatrics. To improve patient care and reduce gaps, it is important to implement interventions at the institutional level as well as to adopt uniform guideline recommendations at the national level.

摘要

儿科医生比家庭医学(FM)临床医生更倾向于开儿科胆固醇筛查医嘱。本研究旨在比较这两个专业的临床医生在儿科胆固醇筛查实践和态度方面的知识、态度和做法。2018 年至 2019 年,我们向机构儿科学和 FM 部门的所有临床医生发送了一份包含 14 个项目的电子调查,采用李克特量表进行。使用卡方检验和 t 检验比较儿科医生和 FM 临床医生。儿科有 22 名临床医生,FM 有 111 名临床医生完成了调查。与 FM 临床医生相比,儿科医生更熟悉国家心肺血液研究所的指南,该指南更强烈地推荐普遍进行胆固醇筛查。儿科医生报告说,他们更支持对儿童进行普遍的胆固醇筛查(p<0.05)。在实践中,儿科医生报告说,在过去一年中,他们对近三分之二(64.8%)符合条件的患者进行了筛查,而 FM 临床医生报告说,他们对大约三分之一(34.1%)符合条件的患者进行了筛查(p<0.001)。儿科医生更有可能根据患者的具体风险因素进行筛查,他们的实践决策受到更多因素的影响,包括发布的指南、机构教育、是否可获得用于筛查的非空腹血液以及是否有机构儿科脂质诊所(p<0.05)。在胆固醇筛查方面的知识、态度和做法的差异可能导致 FM 和儿科临床医生之间的筛查率不同。为了改善患者护理并减少差距,重要的是要在机构层面实施干预措施,并在国家层面采用统一的指南建议。

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