背景:心血管疾病(CVD)是癌症幸存者发病和死亡的主要原因。心理健康被认为是影响心血管疾病治疗的重要危险因素。然而,对同时患有癌症和CVD的患者使用CVD二级预防策略知之甚少.本研究旨在比较初级保健慢性病管理计划的利用率,有和没有癌症的CVD患者的精神健康护理和指南指示的心脏保护药物。
方法:回顾性横断面研究利用来自澳大利亚50个初级保健实践的CVD患者的临床数据。结果包括使用慢性病管理计划,精神卫生保健,指南指示的心脏保护药物和流感疫苗接种。Logistic回归,按实践计算人口统计学和临床协变量和聚类效应,对两组进行比较。
结果:在15,040名CVD患者中,1,486名患者(9.9%)同时患有癌症。癌症患者,与没有的相比,年龄较大(77.6岁vs71.8岁,p<0.001),更有可能饮酒(62.6%对55.7%,p<0.001),收缩压较低(130.3±17.8vs132.5±21.1mmHg,p<0.001)和舒张压(72.2±11vs75.3±34mmHg,p<0.001)血压。虽然对两组都不理想,癌症患者更有可能有全科医学管理计划(GPMPs)(51.4%vs43.2%,p<0.001),团队护理安排(TCA)的协调(46.2%对37.0%,p<0.001),对GPMP或TCA进行审查(42.8%对34.7%,p<0.001),有心理健康治疗咨询(15.4%和10.5%,p=0.004)和处方降压药(70.1%vs66.0%,p=0.002)。然而,降脂或抗血小板药物的处方无统计学差异.在调整协变量和多重测试后,癌症患者的GPMPs没有表现出差异,TCA,以及对两者的回顾,但与没有癌症的患者相比,他们更有可能接受心理健康治疗咨询(比值比1.76;95%置信区间1.42-2.19).
结论:少于一半的CVD患者有GPMP,TCA或审查两者之一。尽管那些癌症患者更有可能接受这些干预措施,大约一半的患者没有。医疗保险资助的GPMP,TCA和对GPMP或TCA的审查未得到充分利用,未来的研究应寻求确定改善获得这些服务的方法。
BACKGROUND: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among cancer survivors. Mental health is considered an important risk factor affecting the treatment of cardiovascular disease. However, little is known about the use of secondary prevention strategies for CVD in patients with both cancer and CVD. This
study aimed to compare the utilisation of primary care chronic disease management plans, mental health care and guideline-indicated cardioprotective medications among CVD patients with and without cancer.
METHODS: Retrospective cross-sectional
study utilising clinical data of patients with CVD from 50 Australian primary care practices. Outcomes included the use of chronic disease management plans, mental health care, guideline-indicated cardioprotective medications and influenza vaccination. Logistic regression, accounting for demographic and clinical covariates and clustering effects by practices, was used to compare the two groups.
RESULTS: Of the 15,040 patients with CVD, 1,486 patients (9.9%) concurrently had cancer. Patients with cancer, compared to those without, were older (77.6 vs 71.8 years, p<0.001), more likely to drink alcohol (62.6% vs 55.7%, p<0.001), have lower systolic (130.3±17.8 vs 132.5±21.1 mmHg, p<0.001) and diastolic (72.2±11 vs 75.3±34 mmHg, p<0.001) blood pressure. Although suboptimal for both groups, patients with cancer were significantly more likely to have general practice management plans (GPMPs) (51.4% vs 43.2%, p<0.001), coordination of team care arrangements (TCAs) (46.2% vs 37.0%, p<0.001), have a review of either GPMP or TCA (42.8% vs 34.7%, p<0.001), have a mental health treatment consultation (15.4% vs 10.5%, p=0.004) and be prescribed blood pressure-lowering medications (70.1% vs 66.0%, p=0.002). However, there were no statistical differences in the prescription of lipid-lowering or antiplatelet medications. After adjustments for covariates and multiple testing, patients with cancer did not show a difference in GPMPs, TCAs, and a review of either, but were more likely to receive mental health treatment consultations than those without cancer (odds ratio 1.76; 95% confidence interval 1.42-2.19).
CONCLUSIONS: Less than half of patients with CVD had a GPMP, TCA or review of either. Although those patients with cancer were more likely to receive these interventions, still around half the patients did not. Medicare-funded GPMPs, TCAs and a review of either GPMP or TCA were underutilised, and future studies should seek to identify ways of improving access to these services.