Brand D A, Newcomer L N, Freiburger A, Tian H
Center for Health Care Policy and Evaluation and Medical Services Group, United HealthCare Corporation, Minneapolis, Minnesota, USA.
J Am Coll Cardiol. 1995 Nov 15;26(6):1432-6. doi: 10.1016/0735-1097(95)00362-2.
Our purpose was to measure cardiologists' level of adherence to guidelines for long-term use of beta-adrenergic blocker therapy after acute myocardial infarction.
Beta-blocker therapy after acute myocardial infarction has been shown to reduce the incidence of reinfarction and associated mortality. To learn about cardiologists' use of this therapy after hospital discharge and their level of adherence to American College of Cardiology guidelines, we analyzed insurance claims from 17 network-model health plans located throughout the United States.
The study group included 150 cardiologists who had contracts with one of the health plans and their 280 patients who were plan members (excluding Medicare enrollees) and received inpatient treatment for acute myocardial infarction that did not include revascularization during 1992. These patients accounted for 307 separate hospital admissions. Insurance claims were used to measure beta-blocker usage and to identify possible contraindications.
Forty-three percent of the cases (131 of 307) involved apparent deviations from the guidelines: 11% of cases (35 of 307) involved possible errors of commission (beta-blocker given in the presence of a contraindication) and 31% (96 of 307) errors of omission (beta-blocker not given in the absence of a contraindication). Of the 185 patients who were eligible for the therapy (no contraindications), only 48% (89 of 185) were treated.
Cardiologists currently exhibit a low level of compliance with their specialty's guidelines for postinfarction beta-blockade. Slightly fewer than 50% of the study patients who were eligible for treatment actually received a beta-blocker after hospital discharge. This result, combined with the drug's known level of effectiveness in preventing recurrent myocardial infarction, suggests that increased use could avert approximately 1,900 deaths annually nationwide.
我们的目的是衡量心脏病专家对急性心肌梗死后β-肾上腺素能阻滞剂长期治疗指南的遵循程度。
急性心肌梗死后的β受体阻滞剂治疗已被证明可降低再梗死发生率及相关死亡率。为了解心脏病专家在出院后对该治疗方法的使用情况及其对美国心脏病学会指南的遵循程度，我们分析了来自美国各地17个网络模式健康计划的保险理赔数据。
研究组包括150名与其中一个健康计划签有合同的心脏病专家及其280名作为计划成员（不包括医疗保险参保者）的患者，这些患者在1992年因急性心肌梗死接受了不包括血管重建术的住院治疗。这些患者共有307次单独的住院记录。保险理赔数据用于衡量β受体阻滞剂的使用情况并确定可能的禁忌症。
43%的病例（307例中的131例）明显偏离指南：11%的病例（307例中的35例）可能存在用药错误（在有禁忌症的情况下给予β受体阻滞剂），31%（307例中的96例）存在漏用错误（在无禁忌症的情况下未给予β受体阻滞剂）。在185名符合治疗条件（无禁忌症）的患者中，只有48%（185例中的89例）接受了治疗。
心脏病专家目前对其专业领域的梗死后β受体阻滞剂治疗指南的依从性较低。在符合治疗条件的研究患者中，出院后实际接受β受体阻滞剂治疗的不到50%。这一结果，再加上该药物在预防复发性心肌梗死方面已知的有效性，表明增加使用量每年可在全国范围内避免约1900例死亡。
