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背景 指南中关于心血管疾病(CVD)风险的重新评估间隔不明确,导致临床实践存在差异:间隔过短会导致过度治疗,造成更大的医疗负担;间隔过长又可能导致忽视需药物治疗的高危患者。本文旨在了解全科医生决定CVD患者重新评估间隔时所考虑的因素。方法本文结合了两项独立的关于CVD风险管理研究的定量和定性数据。试验研究:144位澳大利亚全科医生阅读随机选择的假想病例的调查问卷,血压、胆固醇、5年绝对风险均系统地在调查问卷中呈现。询问全科医生如何处理病例,并开放式询问何时重新评估患者。访谈研究:在试验研究纳入的全科医生外,另经立意抽样选取25位澳大利亚全科医生进行半结构式访谈,采用框架分析法对转录的音频进行主题编码。结果 试验研究:全科医生表示会在6个月或更短时间内重新评估大多数不同绝对风险类别的患者[AR低=52%,95%CI(47%,57%);AR中=82%,95%CI(76%,86%);AR高=87%,95%CI(82%,90%);AR总计=71%,95%CI(67%,75%)],3个月内重新评估的患者占48%[95%CI(43%,53%)]。75%[95%CI(70%,79%)]的低中度AR(≤15%)患者和具有1项使风险升高因素的患者在6个月内进行重新评估。访谈研究:全科医生识别出影响重新评估间隔的危险因素检测的不同作用,这些因素包括患者感知到的社会心理获益,使患者准备好进行药物治疗,以及发现改变生活方式和服药依从性的障碍。患者改变生活方式的动机、患者需求、个体危险因素和全科医生态度影响重新评估和监测间隔。结论 相同风险状况患者重新评估间隔存在差异,表明全科医生未遵守澳大利亚指南中重新评估的建议。对低中等AR患者在较短间隔内重新评估,可能导致不必要的花费和过度治疗。
The background guidelines for ambiguous reevaluation of cardiovascular disease (CVD) risk lead to differences in clinical practice: short intervals lead to over-treatment, resulting in a greater medical burden; long intervals can lead to neglect of medication High-risk patients. This article aims to understand the factors that general practitioners consider when deciding CVD patients to reevaluate intervals. Methods This article combines two separate quantitative and qualitative data on CVD risk management research. Pilot Study: A total of 144 Australian GPs read a random sample of selected hypothetical cases. Blood pressure, cholesterol, and 5-year absolute risk were systematically presented in the questionnaire. Ask general practitioners how to handle the case and ask open questions about when to reassess the patient. Interview study: In addition to the GPs involved in the pilot study, 25 Australian GPs were selected for semi-structured interviews through deliberate sampling, and the transcribed audio was subject-coded using the framework analysis method. Results Trial Study: The GP states that patients in most different absolute risk groups will be re-evaluated in 6 months or less (AR low = 52%, 95% CI (47%, 57%); AR = 82 AR = 87%, 95% CI (82%, 90%); AR total = 71%, 95% CI (67%, 75%)], 3 Patients reassessed during the month accounted for 48% [95% CI (43%, 53%)]. Patients with low to moderate AR (≤15%) with 75% [95% CI (70%, 79%]] and one with elevated risk factors were reassessed within 6 months. Interview study: The general practitioner identifies the different effects of risk factor testing on re-evaluation intervals, including patient-perceived psychosocial benefits, patient preparation for medication, and changes in lifestyle and medication adherence obstacle. Motivation for patient lifestyle changes, patient needs, individual risk factors, and general practitioner attitudes affect reassessments and monitoring intervals. Conclusions There was a difference in reevaluation intervals among patients with the same risk status, indicating that the GP did not comply with the Australian guidelines for reassessment. Reassessment of patients with low-intermediate AR within shorter intervals may result in unnecessary costs and over-treatment.