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基层医疗中的血压和胆固醇测量:动态队列的横断面分析

Blood pressure and cholesterol measurements in primary care: cross-sectional analyses in a dynamic cohort.

作者信息

de Boer Annemarijn R, Hollander Monika, van Dis Ineke, Visseren Frank Lj, Bots Michiel L, Vaartjes Ilonca

机构信息

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

Dutch Heart Foundation, The Hague, The Netherlands.

出版信息

BJGP Open. 2022 Aug 30;6(2). doi: 10.3399/BJGPO.2021.0131. Print 2022 Jun.

Abstract

BACKGROUND

Guidelines on cardiovascular risk management (CVRM) recommend blood pressure (BP) and cholesterol measurements every 5 years in men aged ≥40 years and (post-menopausal) women aged ≥50 years.

AIM

To evaluate CVRM guideline implementation.

DESIGN & SETTING: Cross-sectional analyses in a dynamic cohort using primary care electronic health record (EHR) data from the Julius General Practitioners' Network (JGPN) ( = 388 929).

METHOD

Trends (2008-2018) were assessed in the proportion of patients with at least one measurement (BP and cholesterol) every 1, 2, and 5 years, in those with:1. a history of cardiovascular disease (CVD) and diabetes mellitus (DM);2. a history of DM only;3. a history of CVD only;4. a cardiovascular risk assessment (CRA) indication based on other medical history, or;5. no CRA indication.Trends were evaluated over time using logistic regression mixed-model analyses.

RESULTS

Trends in annual BP and cholesterol measurement increased for patients with a history of CVD from 37.0% to 48.4% (<0.001) and 25.8% to 40.2% (<0.001). In the 5-year window from 2014-2018, BP and cholesterol measurements were performed respectively in 78.5% and 74.1% of all men aged ≥40 years and 82.2% and 78.5% of all women aged ≥50 years. Least measured were patients without a CRA indication (men 60.2% and 62.4%; women 55.5% and 59.3%).

CONCLUSION

The fairly high frequency of CVRM measurements available in the EHR of patients in primary care suggests an adequate implementation of the CVRM guideline. As nearly all individuals visit the GP at least once within a 5-year time window, improvement of CVRM remains possible, especially in those without a CRA indication.

摘要

背景

心血管风险管理(CVRM)指南建议,年龄≥40岁的男性和年龄≥50岁(绝经后)的女性每5年测量一次血压(BP)和胆固醇。

目的

评估CVRM指南的实施情况。

设计与设置

使用来自朱利叶斯全科医生网络(JGPN)(n = 388929)的初级保健电子健康记录(EHR)数据,对一个动态队列进行横断面分析。

方法

评估了2008 - 2018年期间,每1年、2年和5年至少进行一次测量(血压和胆固醇)的患者比例的趋势,这些患者包括:1. 有心血管疾病(CVD)和糖尿病(DM)病史的患者;2. 仅有DM病史的患者;3. 仅有CVD病史的患者;4. 根据其他病史有心血管风险评估(CRA)指征的患者;5. 无CRA指征的患者。使用逻辑回归混合模型分析评估随时间的趋势。

结果

有CVD病史的患者每年血压和胆固醇测量的趋势从37.0%增加到48.4%(P<0.001)和从25.8%增加到40.2%(P<0.001)。在2014 - 2018年的5年期间,年龄≥40岁的所有男性中,分别有78.5%和74.1%进行了血压和胆固醇测量;年龄≥50岁的所有女性中,分别有82.2%和78.5%进行了测量。测量最少的是无CRA指征的患者(男性为60.2%和62.4%;女性为55.5%和59.3%)。

结论

初级保健患者的电子健康记录中CVRM测量的频率相当高,这表明CVRM指南得到了充分实施。由于几乎所有个体在5年时间窗内至少看一次全科医生,CVRM仍有改进的可能,特别是在那些无CRA指征的患者中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cf2/9447314/4f2b42a48a19/bjgpopen-6-0131-f1.jpg

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