Management of Cardiovascular Risk Factors in High Risk Patients: Correlates of Quality of Care

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Izvleček

Izhodišča: Bolezni srca in ožilja (BSO) predstavljajo vodilni vzrok smrti v večini evropskih držav, njihovo preprečevanje pa predstavlja pomembno nalogo osnovnega zdravstvenega varstva. Ocena dejavnikov tveganja in usmerjene preventivne aktivnosti so posebej pomembne pri visokoogroženih bolnikih. Pomembno je poznati tudi dejavnike, ki vplivajo na uspešnost preventive teh bolezni.

Metode: V presečno raziskavo je bilo z naključnim stratificiranim vzorčenjem vključenih 36 slovenskih ambulant. Vsaka ambulanta je iz registra visokoogroženih vključila 30 bolnikov, ki so izpolnili vprašalnik o življenjskem slogu, kakovosti življenja, samooceni zdravja in o uporabi zdravstvenih storitev. Vir podatkov o dejavnikih tveganja BSO so bile kartoteke bolnikov, z vprašalnikom o ambulanti pa so bila pridobljena vprašanja o obremenjenosti, projektih kakovosti, izobraževanju, informacijski tehnologiji, o preventivnih aktivnostih.

Rezultati: Sodelovalo je 871 bolnikov iz 36 ambulant (80,6 % predvidenega vzorca), starih 62,4 leta (SD±8,6). 22,4 % je bilo kadilcev; priporočeno raven aerobne telesne aktivnosti je vzdrževalo 330 (48,8 %) sodelujočih, najmanj urejen dejavnik tveganja pa je bil indeks telesne mase (29,3kg/m2). V multivariatnem modelu so vsi dejavniki (ambulante, bolniki in zdravniki) statistično značilno napovedali urejenost dejavnikov tveganja (p<0,005, F=2,7, R2 =0,087). Neodvisne spremenljivke bolje urejenih dejavnikov tveganja so bile: ženski spol, višja starost in višja izobrazba bolnika, uporaba informacijskega sistema v ambulanti, organizacija srčno-žilne preventive in zdravnikova profesionalna aktivnost v projektih preventive.

Zaključki: Urejenost dejavnikov tveganja je v največji meri odvisna od značilnosti ambulante, predvsem organizacije na področju preventive, ter od strokovne aktivnosti zdravnika. Vplivajo tudi nekatere splošne značilnosti bolnika. Pomembni so še drugi dejavniki, ki niso bili vključeni v model.

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