Hetlevik I, Holmen J, Krüger O, Holen A
National Institute of Public Health, Community Medicine Research Unit, Verdal, Norway.
Scand J Prim Health Care. 1997 Sep;15(3):134-40. doi: 10.3109/02813439709018503.
To assess physicians' current adherence to the Norwegian clinical guidelines for the treatment of hypertension.
Descriptive, retrospective registration of information from patient records of one specified year. In addition, mailed questionnaire to examine the representativeness of the participating doctors.
General practice in Sør- and Nord-Trøndelag counties in Norway, 380,000 inhabitants.
In one year 2468 patients were registered with the diagnosis of hypertension in the records of 56 general practitioners. The patients were 57% women and 43% men; 41% were 70 years or older.
Levels of blood pressure in accordance with the recommendations of the Norwegian clinical guidelines for hypertension. Fractions of patients with a measured blood pressure and serum cholesterol in one year.
At least one blood pressure was recorded in 95% of the hypertensive patients during the specified year. The systolic blood pressure was 140 mmHg or less in 25% and 160 mmHg or less in 65%, while the diastolic blood pressure was 90 mmHg or less in 61%. According to the Norwegian clinical guidelines for systolic blood pressure, 29% of the women and 21% of the men were above recommended levels for treatment. With respect to the diastolic blood pressure, the figures were 38% for women and 40% for men. Patients under 60 years of age were often not treated according to the recommendations. Serum cholesterol was not recorded during the specified year in 68% of the total group, nor in 55% of patients aged 65 years or younger.
There are still major discrepancies between current practice and the intentions laid down in the Norwegian clinical guidelines. A discussion of alternative methods for implementation and for evaluation of the efficacy of clinical guidelines is needed.
评估医生目前对挪威高血压治疗临床指南的遵循情况。
对某一特定年份患者记录中的信息进行描述性回顾性登记。此外，通过邮寄问卷来检验参与医生的代表性。
挪威南特伦德拉格郡和北特伦德拉格郡的普通医疗，居民38万。
在一年时间里，56名全科医生的记录中登记了2468例诊断为高血压的患者。患者中女性占57%，男性占43%；41%的患者年龄在70岁及以上。
符合挪威高血压临床指南建议的血压水平。一年内测量血压和血清胆固醇的患者比例。
在特定年份，95%的高血压患者至少记录了一次血压。收缩压在140 mmHg及以下的患者占25%，在160 mmHg及以下的占65%，而舒张压在90 mmHg及以下的占61%。根据挪威临床指南中收缩压的标准，29%的女性和21%的男性高于推荐治疗水平。就舒张压而言，女性为38%，男性为40%。60岁以下的患者往往未按照建议进行治疗。在特定年份，68%的患者未记录血清胆固醇，65岁及以下患者中这一比例为55%。
目前的实践与挪威临床指南规定的目标仍存在重大差异。需要讨论实施和评估临床指南疗效的替代方法。
