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【medical-news】与血压无关的疾病也会影响降压效
1 May 2008
MedWire News: Clinicians may be less likely to intensify treatment for uncontrolled hypertension if patients have multiple unrelated conditions, a study of more than 70,000 primary care visits has revealed.
Barbara Turner (University of Pennsylvania School of Medicine, Philadelphia, USA) and colleagues examined the quality of care of 15,459 patients who were seen at one of six primary care practices in Philadelphia with uncontrolled hypertension.
Electronic records revealed that approximately 60% of patients had two or more unrelated comorbid conditions, ranging from gastroesophageal reflux to emphysema.
At clinic visits, the odds that treatment for uncontrolled hypertension would be intensified decreased as the number of unrelated comorbid conditions increased.
The adjusted odds ratio for treatment intensification fell from 0.82 for patients with one unrelated comorbid condition to 0.56 for those with seven or more such conditions, relative to patients with no unrelated comorbidities.
Treatment intensification was more likely to occur in visits from patients with related, vascular comorbid conditions, such as coronary artery disease, than those with other conditions.
Of the 28 unrelated comorbid conditions analyzed, nonrheumatoid arthritis had one of the strongest negative associations with treatment intensification.
The researchers note that arthritis is a costly disease that often greatly compromises patient function and productivity, and requires substantial provider effort to manage.
"The provider may be in a quandary about whether to attend to the patient's arthritic needs or take care of conditions that are evaluated by quality measures," they suggest in the Annals of Internal Medicine.
The team concludes: "Our study should add weight to arguments that clinical complexity, as reflected by unrelated comorbid conditions, should be considered when evaluating quality of care."
Ann Intern Med 2008; 148: 578-586
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作者:admin@医学,生命科学 2010-10-14 05:11
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