改进血脂检验报告单前后门诊患者调脂治疗知识和行为调查

Effects of blood-lipid report＇s reformat on outpatients＇ behavior and knowledge of dyslipidemia therapy

目的探讨改进血脂检验报告单对门诊患者渊脂治疗知识和行为的影响。方法2010年7月至2011年6月改进血脂报告单模式，将报告单背面加入《中国成人血脂异常防治指南》核心表格内容。改进前后在调脂治疗相关门诊分别抽取483例和464例患者进行调脂治疗知识和行为的问卷式调查。结果化验单改进前后符合入选标准的患者对自身危险分层判断的正确率分别是26．O％（112／430）和26．3％（115／438），对于“不同危险分层不同LDL—C目标值”的知晓率分别为37．0％（159／430）和35．8％（157／438），仅有0．7％（2／306）和1．0％（3／299）的患者知晓自己的调脂目标（P=0．557）。报告单显示血脂水平正常时，患者遵医嘱服药率改进前后分别为47．6％（230／483）和46．6％（216／464），分别有20．5％（99／483）和19．0％（88／464）质疑处方，不服药比例分别为31．9％（154／483）和34．5％（160／464）（P〉0．05）。存i忙4脂药物治疗患者中，改进前后低危和中危者的治疗率分别为13．3％（2／15）和75．0％（9／12）（P=0．002），高危者分别为54．0％（101／198）和56．8％（130／229），极高危者分别为62．4％（58／93）和69．0％（40／58）（P〉0．05）。改进前后患者总体调脂达标率分别为41．5％（102／245）和44．5％（114／256），极高危者分别为17．9％（12／68）和21．6％（11／52）（P〉0．05）。结论改进血脂检验报告单没有改善患者的血脂达标率、治疗葺罨和患者tLH药依从性；应尝试将患者教育与血脂报告单改进相结合的模式。

Objective To evaluate the effects of blood-lipid report＇s reformat on outpatients＇ behavior and knowledge of dyslipidemia therapy. Methods The blood-lipid report was reformatted by adding three tables fi＇om the Chinese Guideline on the Prevention and Treatment of Adult Dyslipidemia on its back. The same questionnaire was used twice to evaluate the patients＇ behavior and knowledge of dyslipidemia therapy before and after retormat. Results Before and after reformat, the rates of correct determination of their own risk stratification were 26.0% （112/430） and 26. 3% （115/438） respectively. The awareness rates of Different LDL-C goals among different persons were 37.00/0 （159/430） and 35.8% （157/438）. Only 0. 7% （2/306） and 1.0% （3/299） of patients knew their blood lipid goals （P = 0. 557）. When the report showed normal blood lipid levels, the percentages of taking lipid-lowering drug were 47.6% （ 230/483 ） and 46. 6% （ 216/464 ）, 20.5% （ 99/483 ） and 19.0% （88/464） of patients questioned the prescription. Non-medication rates were 31.9% （154/483）and 34.5% （160/464） respectively before and after reformat （ P 〉 0. 05 ）. For patients requiring lipid-lowering drug therapy by the guideline, treatment rate improved significantly in the low-risk group （13.3% vs. 75.0%, P = 0. 002）. Treatment rate slightly increased in the high-risk and very high-risk groups after reformat （54.0% vs. 56. 8% , 62. 4% vs. 69.0% , P 〉0. 05）. Rates of achieving lipid goal showed no change [41.5% （ 102/ 245） vs. 44. 5% （114/256）, P 〉 0. 05 ] after reformat, especially among the very high-risk patients [ 17.9% （12/68） vs. 21.6% （ 11/52）, P 〉 0. 05 ]. Conclusions The blood-lipid report reformat did not improve the patient behaviors and knowledge of the prevention and treatment of dyslipidernia because of poor treatment rate and medication compliance. The combination of patient education and thorough blood-lipid report reformat may help to increase the attainment rate of dyslipidemia therapy.