ABSTRACT
Objective:To investigate the efficacy of personalized family doctor contract services on risk factors of atherosclerotic cardiovascular disease (ASCVD) in high-risk population.Methods:Ten matched-community health centers of Shenzhen Luohu district were divided into intervention group and control group by cluster randomiztion. Subjects with high risks of ASCVD were screened out as intervention group from contracted residents who visited these centers and had complete data of the China-PAR model from August 2018 to April 2019. The control group received conventional general family doctor contract services. The individualized management were given to the intervention group after fully understanding patients′ ideas, concerns, and expectations (ICE). After 2-year intervention, score changes of ASCVD risk factors within and between groups were compared.Results:A total of 571 patients were enrolled, including 288 in the intervention group and 283 in the control group. After 2 years of intervention, 7 and 18 were lost to follow-up in two groups, respectively. Finally, 281 in the intervention group and 265 in the control group were included in the study. At baseline, there was no significant difference in ASCVD scores between the intervention group and the control group [(13.33±3.54) vs. (13.09±3.54) points; t=0.84, P=0.403], and the scores in both groups decreased significantly after the intervention [(10.89±4.01), (11.62±4.11) points], while the intervention group decreased more significantly (both P<0.05). Among the risk factors at baseline, HDL-C and diastolic blood pressure in the intervention group were lower than those in the control group, and there were no significant differences in other factors between the two groups. After the intervention, the levels of total cholesterol, systolic blood pressure and diastolic blood pressure in the two groups decreased significantly, and the number of people taking antihypertensive drugs increased significantly ( P<0.001 and P<0.05); HDL-C decreased in the control group ( P=0.023). After the intervention, compared to control group the intervention group had a higher proportion of patients taking antihypertensive drugs, with lower systolic and diastolic blood pressure ( P<0.05). After the intervention, the increase rate of HDL-C in the intervention group was more than that in the control group, and the decrease rate was less than that in the control group (χ 2=6.65, P=0.036). Conclusion:Family doctor contract services can reduce the risk factors of ASCVD, and personalized family doctor contract services can further improve the effects in the prevention and control of ASCVD. However, the effects might be insignificant and inconsistent for the ASCVD risk factors with deeper management requirements or no specific management measures, which highlights the complexity and diversity of ASCVD prevention and control, calling for multi-level and multi-faceted thinking and exploration.
ABSTRACT
Objective:To investigate the knowledge of the disease and demands of medical intervention in high-risk individuals of arteriosclerotic cardiovascular diseases (ASCVD).Methods:The 10-year ASCVD incidence risk prediction model was used to screen ASCVD high-risk individuals from Luohu district of Shenzhen city. From October 2018 to April 2019,a semi-structured in-depth interview was conducted among ASCVD high-risk individuals selected by stratified sampling method according to age, gender and educational level. The original data were analyzed with Colaizzi′s seven-step analysis method.Results:Total 37 interviewees were enrolled with an average age of (65.2±8.9) years and with an average ASCVD risk value of (14.2±3.2). Three themes were extracted from the interview, including: (1) Majority interviewees had better Knowledge about the hazards and risk factors of ASCVD; (2) Most of the interviewees had lower medical demands; (3) The interviewees were more likely to focus on symptomatic diseases or diseases disturbing them.Conclusions:The asymptomatic high-risk ASCVD individuals generally have better awareness of ASCVD and less demands for intervention. The result indicates that for health education, not only the knowledge, but also the attitude and behavior should be enhanced.