Hahn D L
Arcand Park Clinic, Division of Dean Medical Center, Madison, Wisconsin 53704.
J Am Board Fam Pract. 1993 Nov-Dec;6(6):529-36.
Physicians rarely offer clinical preventive services to patients during acute care visits, but only a minority of patients schedule health maintenance visits. Consequently, many eligible patients never receive appropriate preventive care. Successful strategies are needed to deliver preventive services during acute care visits.
This study tested the feasibility and effectiveness of a simple, physician-initiated protocol for management of hypercholesterolemia in one nonacademic community primary care (family practice) practice. Cholesterol testing was offered to all adult patients (aged 18 years or older) encountered by the clinician during acute care visits, as well as during scheduled health maintenance visits. Mailed notification of cholesterol risk status with a recommendation to follow a prudent (Step I) diet was the main intervention. Some high-risk patients additionally received formal dietary counseling and lipid-lowering medication as clinically warranted.
A total of 1334 patients (95 percent of the eligible clinical population) accepted cholesterol testing, and 158 (11.8 percent) had high cholesterol (> or = 240 mg/dL). For the 114 patients (72.2 percent) with high cholesterol (mean 275.1 mg/dL) who returned for follow-up, cholesterol change 1 year after screening was -9.2 percent (P < 0.001, compared with base line). This decrease could not be explained by expected temporal trends or regression to the mean. Assuming unchanged cholesterol values for patients not followed up, decrease for the entire clinical population with high cholesterol was -6.8 percent (95 percent confidence interval -4.9 to -8.6 percent).
Systematic cholesterol screening during acute care visits is a feasible and effective adjunct to screening during health maintenance visits in this practice. Because most people eventually visit a primary care physician, offering clinical preventive services during acute care visits might be an effective method for reaching the entire clinical population.
在急性病护理就诊期间，医生很少为患者提供临床预防服务，但只有少数患者安排健康维护就诊。因此，许多符合条件的患者从未接受过适当的预防护理。需要成功的策略在急性病护理就诊期间提供预防服务。
本研究在一个非学术性社区初级保健（家庭医疗）机构中测试了一种简单的、由医生发起的高胆固醇血症管理方案的可行性和有效性。在急性病护理就诊期间以及定期健康维护就诊期间，为临床医生接诊的所有成年患者（年龄18岁及以上）提供胆固醇检测。通过邮寄通知胆固醇风险状况并建议遵循谨慎（第一步）饮食是主要干预措施。一些高危患者还根据临床需要接受了正式的饮食咨询和降脂药物治疗。
共有1334名患者（占符合条件临床人群的95%）接受了胆固醇检测，158名（11.8%）胆固醇水平高（≥240mg/dL）。对于114名胆固醇水平高（平均275.1mg/dL）且返回接受随访的患者，筛查后1年胆固醇变化为-9.2%（与基线相比，P<0.001）。这种下降无法用预期的时间趋势或均值回归来解释。假设未接受随访患者的胆固醇值不变，整个高胆固醇临床人群的下降为-6.8%（95%置信区间-4.9至-8.6%）。
在本机构中，急性病护理就诊期间的系统性胆固醇筛查是健康维护就诊期间筛查的可行且有效的辅助手段。由于大多数人最终会去看初级保健医生，在急性病护理就诊期间提供临床预防服务可能是覆盖整个临床人群的有效方法。
