Eaton C B, Monroe A, McQuade W, Eimer M J
Department of Family Medicine, Memorial Hospital of Rhode Island and Brown University School of Medicine, Pawtucket 02860, USA.
J Am Board Fam Pract. 1998 May-Jun;11(3):180-6. doi: 10.3122/15572625-11-3-180.
We wanted to compare the frequency of cholesterol testing and treatment of hypercholesterolemia in patients cared for by family physicians, general internists, and cardiologists.
This study was a continuous cross-sectional survey of 1991 ambulatory office visits using a national probability sample of US physicians' office practices (National Ambulatory Care Survey). The physicians surveyed self-reported their specialty as family practice, internal medicine, or cardiology. Records of 33,795 patient visits to 1354 physicians were reviewed to find out whether the physicians reported cholesterol testing, cholesterol counseling, and charting of patient use of lipid-lowering medications. The results were compared among the three specialist groups.
During an annual health examination (9.77 million office visits), a cholesterol test was reported by 23.5 percent of family physicians, 43.5 percent of internists, and 13.1 percent of cardiologists (P < 0.01). For all hypercholesterolemic patients (23.52 million office visits), the age- and sex-adjusted percentages of reported cholesterol-reduction counseling during office visits were 38.3 percent for family physicians, 42.4 percent for internists, and 36.5 percent by cardiologists (NS), and percentages of reported lipid-lowering medication prescriptions were 13.4 percent for family physicians, 25.1 percent for internists, and 28.4 percent for cardiologists (P < 0.01). In hypercholesterolemic patients with coronary heart disease (3.47 million office visits), the age- and sex-adjusted percentages of cholesterol reduction counseling reported during office visits were 64.4 percent for family physicians, 47.1 percent for internists, and 35.9 percent for cardiologists (NS) and the age- and sex-adjusted percentages of lipid-lowering medication prescriptions reported were 13.9 percent for family physicians, 62.5 percent for internists, and 34.7 percent for cardiologists (P < 0.01).
Recommended goals regarding cholesterol testing and management were not reached by any physician group. Internists tested for hypercholesterolemia during an annual health examination more frequently and had more patients using lipid-lowering medications than did family physicians or cardiologists. Understanding the reasons for these specialty differences might lead to improvement in the diagnosis and management of hypercholesterolemia and therefore reduction in cardiovascular disease.
我们希望比较家庭医生、普通内科医生和心脏病专家所诊治患者的胆固醇检测频率以及高胆固醇血症的治疗情况。
本研究是一项连续性横断面调查，采用美国医生门诊诊疗的全国概率样本（全国门诊医疗调查），对1991次门诊就诊进行调查。接受调查的医生自我报告其专业为家庭医学、内科或心脏病学。对1354名医生的33795例患者就诊记录进行审查，以了解医生是否报告了胆固醇检测、胆固醇咨询以及患者使用降脂药物的记录情况。对三个专科医生组的结果进行比较。
在年度健康检查期间（977万次门诊就诊），23.5%的家庭医生、43.5%的内科医生和13.1%的心脏病专家报告进行了胆固醇检测（P<0.01）。对于所有高胆固醇血症患者（2352万次门诊就诊），按年龄和性别调整后，门诊就诊时报告的胆固醇降低咨询百分比，家庭医生为38.3%，内科医生为42.4%，心脏病专家为36.5%（无显著性差异），报告的降脂药物处方百分比，家庭医生为13.4%，内科医生为25.1%，心脏病专家为28.4%（P<0.01）。在患有冠心病的高胆固醇血症患者中（347万次门诊就诊），按年龄和性别调整后，门诊就诊时报告的胆固醇降低咨询百分比，家庭医生为64.4%，内科医生为47.1%，心脏病专家为35.9%（无显著性差异），报告的降脂药物处方按年龄和性别调整后的百分比，家庭医生为13.9%，内科医生为62.5%，心脏病专家为34.7%（P<0.01）。
任何医生组都未达到关于胆固醇检测和管理的推荐目标。在内科医生中，年度健康检查期间对高胆固醇血症进行检测的频率更高，使用降脂药物的患者比家庭医生或心脏病专家更多。了解这些专科差异的原因可能会改善高胆固醇血症的诊断和管理，从而降低心血管疾病的发生。
