Stafford R S, Blumenthal D
General Medicine Division, Massachusetts General Hospital, Boston 02114, USA.
J Am Coll Cardiol. 1998 Nov;32(5):1238-43. doi: 10.1016/s0735-1097(98)00380-5.
The aim of this study was to examine physician specialty differences in cardiovascular disease prevention practices.
Despite the importance of cardiovascular disease prevention, little is known about current national practices, particularly physician specialty differences.
Using a national survey of office visits, we evaluated differences in the propensity of physicians of different specialties to provide prevention services. We analyzed 30,929 adult visits to 1,521 physicians selected by stratified random sampling in the 1995 National Ambulatory Medical Care Survey. Standard and ordinal multiple logistic regression models were employed to estimate the independent effects of physician and patient characteristics.
A variety of cardiovascular disease prevention services were provided during an estimated 547 million adult office visits to US physicians in 1995, including blood pressure measurement (50% of visits), cholesterol testing (5%) and counseling for exercise (12%), weight (6%), cholesterol (4%) and smoking (3%). In addition, medication management was reflected by the report of antihypertensives in 12% of visits and lipid-lowering medications in 2%. Across these eight services, propensity to provide services varied consistently with specialty. Controlling for patient and visit characteristics and compared to general internists, the likelihood of providing services was higher for cardiologists (adjusted odds ratio 1.65, 95% confidence interval 1.44 to 1.89) but lower for obstetrician/gynecologists (0.75, 0.68 to 0.82), family physicians (0.69, 0.64 to 0.74), general practitioners (0.58, 0.53 to 0.63), other medical specialists (0.65, 0.59 to 0.72) and surgeons (0.06, 0.05 to 0.06).
Cardiologists have the greatest propensity to provide cardiovascular disease prevention services, while primary care physicians vary substantially in their practices. These findings suggest a need to address variations in cardiovascular disease prevention.
本研究旨在探讨不同内科专业医生在心血管疾病预防措施方面的差异。
尽管心血管疾病预防至关重要，但目前对于全国范围内的实际情况，尤其是不同内科专业医生之间的差异，了解甚少。
通过一项针对门诊就诊情况的全国性调查，我们评估了不同专业医生提供预防服务倾向的差异。我们分析了1995年全国门诊医疗护理调查中通过分层随机抽样选取的1521名医生的30929例成人就诊病例。采用标准和有序多元逻辑回归模型来估计医生和患者特征的独立影响。
1995年美国医生估计接待了5.47亿例成人门诊就诊，期间提供了多种心血管疾病预防服务，包括血压测量（就诊病例的50%）、胆固醇检测（5%）以及运动咨询（12%）、体重咨询（6%）、胆固醇咨询（4%）和吸烟咨询（3%）。此外，12%的就诊病例报告了抗高血压药物治疗情况，2%的病例报告了降脂药物治疗情况，以此反映药物管理情况。在这八项服务中，提供服务的倾向因专业不同而始终存在差异。在控制患者和就诊特征后，与普通内科医生相比，心脏病专家提供服务的可能性更高（调整后的优势比为1.65，95%置信区间为1.44至1.89），而妇产科医生（0.75，0.68至0.82）、家庭医生（0.69，0.64至0.74）、全科医生（0.58，0.53至0.63）、其他医学专科医生（0.65，0.59至0.72）和外科医生（0.06，0.05至0.06）提供服务的可能性较低。
心脏病专家提供心血管疾病预防服务的倾向最大，而初级保健医生的实际操作差异很大。这些发现表明有必要解决心血管疾病预防方面的差异问题。
