Le Goff Delphine, Perraud Gabriel, Aujoulat Paul, Deriennic Jeremy, Guillou Morgane, Barais Marie, Le Reste Jean-Yves
Department of General Practice, University of Western Brittany, Brest, France.
ER 7479 SPURBO, University of Western Brittany, Brest, France.
Front Med (Lausanne). 2023 Jan 16;9:1058090. doi: 10.3389/fmed.2022.1058090. eCollection 2022.
In 2019, cardiovascular diseases (CVD) caused 32% of deaths worldwide. The SPICES survey involved five countries in an international primary CVD prevention implementation study in the general population. The French SPICES survey was implemented in the Centre Ouest Bretagne area (COB), which is a rural, economically deprived, medically underserved territory with high cardiovascular mortality. A CVD screening in the general population was needed to select the implementation population without overburdening family practitioner (FP) workforces. The efficacy and the replicability of such a screening were unknown. The aims of this study were to identify the characteristics of the individuals undergoing CVD risk assessment with the Non-Laboratory Interheart risk score (NL-IHRS), and to identify barriers and explore facilitators when screening the general population.
An implementation study combining a cross-sectional descriptive study with qualitative interviews was undertaken. The NL-IHRS was completed by trained screeners selected from health students, pharmacists, nurses, and physiotherapists in the area with a dedicated e-tool in sport and cultural events and public places. After the screening, all screener groups were interviewed until theoretical saturation for each group. Thematic analysis was performed using double-blind coding.
In 5 months, 3,384 assessments were undertaken in 60 different places, mostly by health students. A total of 1,587, 1,309, and 488 individuals were at low, moderate, and high CVD risk. Stressed or depressed individuals were remarkably numerous (40.1 and 24.5% of the population, respectively). Forty-seven interviews were conducted. The main facilitators were willingness of the population, trust between screeners and the research team, and media publicity. The main barriers were lack of motivation of some screeners, some individuals at risk, some stakeholders and difficulties in handling the e-tool.
The efficacy of CVD risk screening while using mostly health students was excellent and preserved the FP workforce. Replicability was highly feasible if research teams took great care to establish and maintain trust between screeners and researchers. The e-tools should be more user-friendly.
2019年，心血管疾病（CVD）导致全球32%的死亡。SPICES调查涉及五个国家，是一项针对普通人群的国际原发性心血管疾病预防实施研究。法国的SPICES调查在布列塔尼西部中心地区（COB）开展，该地区是一个农村地区，经济贫困，医疗服务不足，心血管疾病死亡率高。需要对普通人群进行心血管疾病筛查，以选择实施人群，同时又不给家庭医生（FP）的工作负担过重。这种筛查的有效性和可重复性尚不清楚。本研究的目的是确定使用非实验室Interheart风险评分（NL - IHRS）进行心血管疾病风险评估的个体特征，并确定在筛查普通人群时的障碍和探索促进因素。
开展了一项将横断面描述性研究与定性访谈相结合的实施研究。NL - IHRS由从该地区的健康专业学生、药剂师、护士和物理治疗师中挑选的经过培训的筛查人员，在体育和文化活动以及公共场所使用专用电子工具完成。筛查后，对所有筛查人员组进行访谈，直至每组达到理论饱和。使用双盲编码进行主题分析。
在5个月内，在60个不同地点进行了3384次评估，主要由健康专业学生进行。共有1587人、1309人和488人处于低、中、高心血管疾病风险。压力大或抑郁的个体数量显著众多（分别占人群的40.1%和24.5%）。进行了47次访谈。主要促进因素是人群的意愿、筛查人员与研究团队之间的信任以及媒体宣传。主要障碍是一些筛查人员缺乏积极性、一些有风险的个体、一些利益相关者以及电子工具使用困难。
主要使用健康专业学生进行心血管疾病风险筛查的效果极佳，且减轻了家庭医生的工作负担。如果研究团队非常谨慎地在筛查人员和研究人员之间建立和维持信任，可重复性是非常可行的。电子工具应更加用户友好。
