Troein M, Arneson T, Råstam L, Pirie P L, Selander S, Luepker R V
Department of Community Medicine, Lund University, Malmö, Sweden.
Am J Prev Med. 1995 Sep-Oct;11(5):324-8.
Swedish guidelines on treatment of hyperlipidemia recommend higher cut-off levels for initiating treatment than do American guidelines, but are virtually identical for instituting and performing therapy. The aim of this study was to compare family physicians' reported practices in Sweden and Minnesota. We selected random samples of family physicians in southern Sweden and Minnesota for telephone interviews. Participation rates were 236/264 (89%) and 183/209 (88%), respectively. Swedish and Minnesota physicians adhered to their guidelines on cut-off levels in a case describing a 48-year-old man but, contrary to guidelines, reported higher cut-off levels for a 65-year-old man and a 65-year-old woman. In all cases described, Swedish physicians reported significantly higher cut-off levels. Swedish physicians were less prone to institute medication in older patients and less familiar with drugs. Minnesota physicians were more inclined to advise nicotinic acid derivatives (P < .0001 for all patient categories). Swedish physicians more frequently preferred resins (P = .00029) or fibrates (P = .0028) for the 48-year-old man and resins for the 65-year-old man (P = .0026). Despite common medical knowledge, the two medical communities are directed by different guidelines. Although adherence to cut-off levels was equally high in both groups, the use of lipid-lowering drugs has not become a familiar part of the therapeutic armamentarium for Swedish family physicians.
瑞典高脂血症治疗指南推荐的起始治疗临界值水平高于美国指南，但在制定和实施治疗方面几乎相同。本研究的目的是比较瑞典和明尼苏达州家庭医生报告的诊疗行为。我们随机抽取了瑞典南部和明尼苏达州的家庭医生进行电话访谈。参与率分别为236/264（89%）和183/209（88%）。在描述一名48岁男性的病例中，瑞典和明尼苏达州的医生遵循了各自关于临界值水平的指南，但与指南相反，在描述一名65岁男性和一名65岁女性的病例中，他们报告的临界值水平更高。在所有描述的病例中，瑞典医生报告的临界值水平显著更高。瑞典医生在老年患者中开药物治疗的倾向较低，且对药物不太熟悉。明尼苏达州的医生更倾向于建议使用烟酸衍生物（所有患者类别P < .0001）。对于48岁男性，瑞典医生更常选择树脂类药物（P = .00029）或贝特类药物（P = .0028），对于65岁男性则更常选择树脂类药物（P = .0026）。尽管有共同的医学知识，但两个医疗群体遵循不同的指南。尽管两组对临界值水平的遵循程度相同，但降脂药物的使用尚未成为瑞典家庭医生治疗手段中常见的一部分。
