北京社区门诊就诊冠心病患者管理质量分析

Analysis of management quality of coronary heart disease patients in community outpatient health service in Beijing

目的 了解社区卫生服务中心就诊冠状动脉粥样硬化性心脏病(冠心病)患者药物治疗、生活方式改善指导及危险因素控制情况,评估冠心病患者管理质量。方法 从北京朝阳区、海淀区选择10个社区卫生服务中心,2019年3月至9月,每个社区卫生服务中心连续收集确诊冠心病患者100例。通过面对面询问、生化检验以及现场体格检查收集患者基本信息、病史、危险因素、药物治疗、生活方式改善和生化检查信息。结果 共收集符合条件的研究对象1052例,年龄66.7±9.5岁,男性563例(53.5%)。91.1%(958/1052)获得饮食改善建议,仅41.8%(440/1052)获得血脂评估建议。5条生活方式改善建议中,获得3条以上(含3条)建议者为83.8%(882/1052),伴有高血压或糖尿病的冠心病患者获得3条以上(含3条)建议的比例显著高于不伴有高血压或糖尿病的患者(85.7%vs.68.3%,P<0.001)。冠心病患者二级预防主要药物应用率分别为:阿司匹林79.6%(837/1052),他汀类53.9%(567/1052),β受体阻滞剂43.6%(459/1052),血管紧张素转换酶抑制剂22.5%(237/1052),血管紧张素受体拮抗剂28.4%(299/1052)。冠脉搭桥或支架植入的患者上述药物应用率显著高于单纯药物治疗患者(P均<0.05)。伴有高血压的患者血压控制达标率为68.6%(596/869),伴有糖尿病的患者空腹血糖达标率为55.6%(207/372);低密度脂蛋白胆固醇<1.8 mmol/L的比例为12.1%(100/829);吸烟患者戒烟率为64.5%(237/366)。5项心血管疾病传统危险因素均控制达标的比例为1.7%(14/828)。结论北京社区就诊冠心病患者生活方式改善建议获得率高,但药物治疗依从性和危险因素控制率还需改善。社区卫生服务应增加他汀类药物应用,并加强对低密度脂蛋白胆固醇疗效的评估。

Objective To investigate the drug therapy,lifestyle improvement guidance,and risk factor control of patients with cardiovascular disease(CVD) in community health service centres and evaluate their management quality.Methods Ten community health service centres were selected from Chaoyang District and Haidian District of Beijing.From March 2019 to September 2019,100 patients confirmed with CVD were collected from each community health service centre.Demographic data,history,risk factors,medication,lifestyle improvements,and biochemical results were collected through face-to-face interviews,laboratory tests,and physical examination.Results A total of 1052 CVD patients(66.7±9.5 years old) were collected,including 563 males(53.5%).91.1%(958/1052) of patients received dietary improvement advice,and only 41.8%(440/1052) received suggestions for dietary improvement.Of the five lifestyle improvement suggestions,83.8%(882/1052) patients received more than 3(including 3) suggestions.The proportion of CVD patients with hypertension or diabetes receiving more than 3(including 3) suggestions was significantly higher than patients without hypertension or diabetes(85.7% vs.68.3%,P<0.001).The application rates of core drugs for secondary prevention in CVD patients were respectively:aspirin 79.6%(837/1052),statins 53.9%(567/1052),β-blockers 43.6%(459/1052),angiotensin-converting enzyme inhibitors 22.5%(237/1052),and angiotensin-receptor antagonists 28.4%(299/1052).The above drug application rates in patients with coronary artery bypass graft or stent implantation were significantly higher than those with drug therapy alone(all P<0.05).The control rate of blood pressure in patients with hypertension was 68.6%(596/869),and the control rate of fasting blood glucose in patients with diabetes was 55.6%(207/372).The proportion of lowdensity lipoprotein cholesterol(LDL-C) <1.8 mmol/L was 12.1%(100/829).The rate of quitting smoking among smokers was 64.5%(237/366).The proportion of all the five traditional cardiovascular disease risk factors was 1.7%(14/828).Conclusion The rate of obtaining suggestions for lifestyle improvement of patients with coronary heart disease in the Beijing community is high.However,the drug treatment compliance and risk factor control rate still need to be improved.Community health services should increase the use of statins and strengthen the evaluation of the therapeutic effect of low-density lipoprotein cholesterol.