Harnick D J, Cohen J L, Schechter C B, Fuster V, Smith D A
Cardiovascular Institute, and the Department of Community Medicine, Mount Sinai School of Medicine, The Mount Sinai Medical Center, New York, New York 10029, USA.
Am J Cardiol. 1998 Jun 15;81(12):1416-20. doi: 10.1016/s0002-9149(98)00209-4.
We undertook a study to determine whether there were differences in the quality of lipid management in patients with coronary artery disease (CAD) in 2 different practice settings (which represent different socioeconomic classes), and to determine the level of compliance with the National Cholesterol Education Program guidelines by academic physicians in managing patients with CAD. A retrospective cross-sectional study was performed using a systematic chart review of 270 medical records (131 from the cardiology clinic, 139 from the cardiology private practice) of patients with known CAD at an academic tertiary care center in New York City. The total proportion of patients with CAD having a lipid profile ordered in the clinic and private suite was 43%. Of these people, 22% had a low-density lipoprotein cholesterol (LDL) < or = 100 mg/dl and 54% had an LDL < or = 130 mg/dl (10% and 23% of the total population, respectively). The total proportion of patients taking lipid-lowering medications was 29%. When comparing the quality of treatment between the 2 settings, there were no statistically significant differences in the percentages of patients who had lipid profiles measured (40% clinic vs 47% private suite, p >0.10), in the percentage of patients with LDL < or = 130 mg/dl (50% clinic vs 57% private suite, p >0.10) or in the weighted percentage of patients taking lipid-lowering medications (29% clinic vs 48% private suite, p = 0.099). The performances of individual physicians, however, varied widely. The percentages of patients with lipid profiles measured by individual physicians ranged from 0% to 83%, while the percentages of patients on drug treatment by a physician ranged between 10% and 88%. These findings indicate that socioeconomic differences, represented by different practice settings, do not account for differences in the screening for, control of, or use of medications in managing hyperlipidemia. Rather, individual physicians are accountable for differences in lipid management.
我们开展了一项研究，以确定在两种不同的医疗环境（代表不同社会经济阶层）中，冠心病（CAD）患者的血脂管理质量是否存在差异，并确定学术型医生在管理CAD患者时对国家胆固醇教育计划指南的遵循程度。我们在纽约市一家学术性三级医疗中心，对270例已知CAD患者的病历（131例来自心脏病诊所，139例来自心脏病私人诊所）进行系统的图表回顾，开展了一项回顾性横断面研究。在诊所和私人诊疗室进行血脂检查的CAD患者总比例为43%。在这些人中，22%的患者低密度脂蛋白胆固醇（LDL）≤100mg/dl，54%的患者LDL≤130mg/dl（分别占总人口的10%和23%）。服用降脂药物的患者总比例为29%。比较两种环境下的治疗质量时，进行血脂检查的患者百分比（诊所为40%，私人诊疗室为47%，p>0.10）、LDL≤130mg/dl的患者百分比（诊所为50%，私人诊疗室为57%，p>0.10）或服用降脂药物患者的加权百分比（诊所为29%，私人诊疗室为48%，p = 0.099），均无统计学显著差异。然而，个体医生的表现差异很大。个体医生进行血脂检查的患者百分比在0%至83%之间，而接受医生药物治疗的患者百分比在10%至88%之间。这些发现表明，由不同医疗环境所代表的社会经济差异，并不能解释在高脂血症管理中筛查、控制或药物使用方面的差异。相反，个体医生应对血脂管理的差异负责。
