Ferris G, Roderick P, Smithies A, George S, Gabbay J, Couper N, Chant A
Wessex Institute for Health Research and Development, University of Southampton, Southampton General Hospital, Southampton SO16 6YD.
BMJ. 1998 Aug 15;317(7156):447-51. doi: 10.1136/bmj.317.7156.447.
To compare the level of provision of carotid endarterectomy (an intervention of proved efficacy for prevention of stroke in patients with symptomatic high grade carotid artery stenosis) with estimates of need.
Comparison of regional, district, and age-sex specific operation rates derived from hospital episode statistics with estimates of need based on demographic and epidemiological data; interviews with regional vascular surgeons and a joint provider-purchaser workshop to discuss implications.
Former Wessex Regional Health Authority, 1991-2 to 1995-6.
All residents covered by Wessex region treated for carotid artery reconstruction.
Regional, district, and age-sex operation rates as three year average 1993-6 (use) compared with respective estimates of need for carotid endarterectomy among those who presented with symptomatic carotid disease-transient ischaemic attack or minor stroke.
The operation rate more than doubled between 1991-2 and 1995-6, from 35 to 89 per million population, compared with an estimated level of need in the region's general population of 153 per million population (transient ischaemic attack 77, minor stroke 76). The ratio of use to need was 0.47 (95% confidence interval 0.4 to 0.54); district ratios were 0.28 (0.19-0.38) to 0.81 (0.62 to 1.06). The annual use:need ratio rose over the three years 1993-6 from 0.38 to 0.59. Use:need ratios were lower in elderly and female patients. Providers were keen to develop guidelines for referral and to increase access to diagnostic facilities; purchasers were more reluctant, given the limited impact of this intervention on the incidence of stroke and the relatively high cost of the operation.
Although treatment rates increased in Wessex there is still unmet need. Further research is needed to determine the referral pathways of patients with symptomatic carotid disease for diagnosis and operation and to evaluate strategies to improve access to diagnostic facilities.
比较颈动脉内膜切除术（一种已证实对有症状的重度颈动脉狭窄患者预防中风有效的干预措施）的提供水平与需求估计。
将医院病历统计得出的地区、区域及年龄性别特异性手术率与基于人口统计学和流行病学数据的需求估计进行比较；对地区血管外科医生进行访谈，并举办提供者 - 购买者联合研讨会以讨论其影响。
原韦塞克斯地区卫生局，1991年2月至1995年6月。
韦塞克斯地区接受颈动脉重建治疗的所有居民。
1993 - 1996年三年平均的地区、区域及年龄性别手术率（使用情况）与有症状颈动脉疾病（短暂性脑缺血发作或轻度中风）患者中颈动脉内膜切除术的各自需求估计进行比较。
1991年2月至1995年6月期间，手术率增加了一倍多，从每百万人口35例增至89例，而该地区普通人群的需求估计水平为每百万人口153例（短暂性脑缺血发作77例，轻度中风76例）。使用与需求的比率为0.47（95%置信区间0.4至0.54）；各区域比率为0.28（0.19 - 0.38）至0.81（0.62至1.06）。1993 - 1996年的年度使用与需求比率从0.38升至至0.59。老年和女性患者的使用与需求比率较低。提供者热衷于制定转诊指南并增加获得诊断设施的机会；购买者则较为犹豫，因为该干预措施对中风发病率的影响有限且手术成本相对较高。
尽管韦塞克斯地区的治疗率有所提高，但仍有未满足的需求。需要进一步研究以确定有症状颈动脉疾病患者的诊断和手术转诊途径，并评估改善获得诊断设施机会的策略。
