School of Population Health, University of New South Wales Faculty of Medicine, Kensington, New South Wales, Australia.
NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia.
Fam Med Community Health. 2023 Aug;11(3). doi: 10.1136/fmch-2023-002251.
To determine the prevalence and associations of general practice registrars' performing absolute cardio-vascular risk (ACVR) assessment (ACVRa).
A cross-sectional study employing data (2017-2018) from the Registrar Clinical Encounters in Training project, an ongoing inception cohort study of Australian GP registrars. The outcome measure was whether an ACVRa was performed. Analyses employed univariable and multivariable regression. Analysis was conducted for all patient problems/diagnoses, then for an 'at-risk' population (specific problems/diagnoses for which ACVRa is indicated).
Three GP regional training organisations (RTOs) across three Australian states.
GP registrars training within participating RTOs.
1003 registrars (response rate 96.8%) recorded details of 69 105 problems either with Aboriginal and/or Torres Strait patients aged 35 years and older or with non-Indigenous patients aged 45 years and older. Of these problems/diagnoses, 1721 (2.5% (95% CI 2.4% to 2.6%)) involved an ACVRa. An ACVRa was 'plausibly indicated' in 10 384 problems/diagnoses. Of these, 1228 (11.8% (95% CI 11.2% to 12.4%)) involved ACVRa. For 'all problems/diagnoses', on multivariable analysis female gender was associated with reduced odds of ACVRa (OR 0.61 (95% CI 0.54 to 0.68)). There was some evidence for Aboriginal and/or Torres Strait Islander people being more likely to receive ACVRa (OR 1.40 (95% CI 0.94 to 2.08), p=0.10). There were associations with variables related to continuity of care, with reduced odds of ACVRa: if the patient was new to the registrar (OR 0.65 (95% CI 0.57 to 0.75)), new to the practice (OR 0.24 (95% CI 0.15 to 0.38)) or the problem was new (OR 0.68 (95% CI 0.59 to 0.78)); and increased odds if personal follow-up was organised (OR 1.43 (95% CI 1.24 to 1.66)). For 'ACVRa indicated' problems/diagnoses, findings were similar to those for 'all problems/diagnoses'. Association with Aboriginal and/or Torres Strait Islander status, however, was significant at p<0.05 (OR 1.60 (95% CI 1.04 to 2.46)) and association with female gender was attenuated (OR 0.88 (95% CI 0.77 to 1.01)).
Continuity of care is associated with registrars assessing ACVR, reinforcing the importance of care continuity in general practice. Registrars' assessment of an individual patient's ACVR is targeted to patients with individual risk factors, but this may entail ACVRa underutilisation in female patients and younger age groups.
确定全科医生住院医师进行绝对心血管风险（ACVR）评估（ACVRa）的流行率和相关性。
横断面研究采用了澳大利亚全科医生住院医师注册项目（Registrar Clinical Encounters in Training 项目）的数据（2017-2018 年），该项目是一项正在进行的澳大利亚全科医生住院医师的入组队列研究。主要结局指标为是否进行了 ACVRa。分析采用单变量和多变量回归。对所有患者的问题/诊断进行了分析，然后对“高危”人群（有指示进行 ACVRa 的特定问题/诊断）进行了分析。
澳大利亚三个州的三个全科医生区域培训组织（RTO）。
参加 RTO 培训的全科医生住院医师。
1003 名住院医师（应答率 96.8%）记录了 69105 个问题，涉及 35 岁及以上的土著和/或托雷斯海峡岛民患者或 45 岁及以上的非土著患者，其中 1721 个（2.5%（95%置信区间 2.4%至 2.6%））涉及 ACVRa。在 10384 个问题/诊断中，ACVRa“可能是合理的”。在这些问题/诊断中，1228 个（11.8%（95%置信区间 11.2%至 12.4%））涉及 ACVRa。对于“所有问题/诊断”，多变量分析显示，女性的 ACVRa 可能性降低（OR 0.61（95%CI 0.54 至 0.68））。有证据表明，土著和/或托雷斯海峡岛民更有可能接受 ACVRa（OR 1.40（95%CI 0.94 至 2.08），p=0.10）。与连续性护理相关的变量存在关联，ACVRa 的可能性降低：如果患者是注册医生的新患者（OR 0.65（95%CI 0.57 至 0.75））、新到诊所（OR 0.24（95%CI 0.15 至 0.38））或问题是新的（OR 0.68（95%CI 0.59 至 0.78））；如果安排了个人随访，则增加了可能性（OR 1.43（95%CI 1.24 至 1.66））。对于“指示进行 ACVRa”的问题/诊断，结果与“所有问题/诊断”的结果相似。然而，与土著和/或托雷斯海峡岛民身份的关联在统计学上具有显著性（OR 1.60（95%CI 1.04 至 2.46）），与女性的关联减弱（OR 0.88（95%CI 0.77 至 1.01））。
连续性护理与住院医师评估 ACVR 相关，这强化了在一般实践中保持护理连续性的重要性。住院医师对个体患者的 ACVR 评估针对的是有个体危险因素的患者，但这可能导致女性患者和年轻患者群体中 ACVRa 的使用不足。
