Background Evidence-based medicine has come into its second decade. How prepared clinicians are in practicing it in particular in developing countries remains unclear. Thus we conducted this survey of physicians in ur...Background Evidence-based medicine has come into its second decade. How prepared clinicians are in practicing it in particular in developing countries remains unclear. Thus we conducted this survey of physicians in urban hospitals in China to determine the size of the gap between research evidence and physicians＇ knowledge and practice regarding antihypertensive drugs for primary prevention of cardiovascular diseases in China.Methods A cross sectional survey by a face-to-face interview was conducted in 20 tertiary general hospitals in China in 2005. A total of 444 physicians （mostly cardiologists） in internal medicine who had treated at least one hypertensive patient in the past 12 months were invited for the interview on their perception of the cardiovascular risk of hypertension,the magnitude of the benefit of antihypertensive drugs, knowledge on the overall risk approach, first-line drugs used, the risk above which drug treatment is recommended, and knowledge on evidence-based medicine.Results A total of 444 of the 468 eligible physicians were successfully interviewed with a response rate of 94.9%. They estimated that a hypertensive man with an actual 5-year cardiovascular risk of 8.4% would have a 5-year cardiovascular risk of 40% （95% CI： 38% to 42%） if not treated, and have an absolute risk reduction and relative risk reduction from drug treatment by 20% （95% CI. 18% to 22%） and 39% （95% CI： 37% to 42%） respectively, as compared to 3.3% and 33%respectively shown in research evidence. On average, the physicians would recommend drug treatment at a number needed to treat （NNT） of 368 or smaller, as compared to the actual NNT of 50 for drug treatment in an average hypertensive Chinese. Fifty-five percent （95% CI： 50% to 59%） of them had never intently used the national hypertension guidelines. The majority still prescribed drugs primarily based on blood pressure alone by ignoring other risk factors or the overall risk and 78% （95 % C/. 76% to 83%） used new expensive drugs such as calcium channel blockers and angiotensin converting enzyme （ACE） inhibitors as first-line treatment. Only 13% （95% CI：9% to 18%） could correctly interpret the NNT. Forty-three percent （95% CI： 39% to 48%） did not know the randomized controlled trial was scientifically the most rigorous among other study designs for evaluating the effectiveness of anti-hypertensive drugs.Ninety-two percent （95% CI： 90% to 94%） did not know they could start by searching systematic reviews when looking for evidence on the effectiveness of anti-hypertensive drugs as opposed to trials. Ninety-six percent （95% CI： 94% to 98%）did not know the Cochrane Library was an important source of systematic reviews.Conclusions The surveyed physicians significantly over-estimated the cardiovascular risk of hypertension and the benefit of drug treatment, and had insufficient knowledge on the overall risk approach. They recommended drug treatment at a cardiovascular risk which was even much lower than the cutoff suggested for western populations, which would make many more people eligible for drug treatment. They also tended to prescribe new expensive drugs although the older cheaper ones may be more appropriate in many patients. They showed inappropriate knowledge on the basics of evidence-based medicine.展开更多
Objective:The recent population census showed China had officially become a graying society.In the meantime,China also faces a growing burden of non-communicable diseases.Since 2009,a series of policies have been impl...Objective:The recent population census showed China had officially become a graying society.In the meantime,China also faces a growing burden of non-communicable diseases.Since 2009,a series of policies have been implemented to enhance primary care at the community level.This study describes the elderly care services provided in the differently organized community health centers(CHCs).Methods:It covered 13 CHCs of six cities located within the Pearl River Delta(PRD)region.In-depth interviews were conducted with a total of 59 health administrators,CHC managers,and CHC doctors regarding elderly care.Results:The study found that accessibility of healthcare for elders has been improved due to the development of health insurance schemes as well as preferential policy to encourage the CHC utilization by the elderly.All the CHCs provide health examinations and chronic disease management to the permanent elderly within their catchment district.However,some preventative care such as fall prevention,immunization and mental health management are not provided.Conclusion:Key barriers include low capacity of health service providers in the CHCs,and a lack of government investment in CHCs.Our report provides an empirical evidence for the health care reform in China.展开更多
文摘Background Evidence-based medicine has come into its second decade. How prepared clinicians are in practicing it in particular in developing countries remains unclear. Thus we conducted this survey of physicians in urban hospitals in China to determine the size of the gap between research evidence and physicians＇ knowledge and practice regarding antihypertensive drugs for primary prevention of cardiovascular diseases in China.Methods A cross sectional survey by a face-to-face interview was conducted in 20 tertiary general hospitals in China in 2005. A total of 444 physicians （mostly cardiologists） in internal medicine who had treated at least one hypertensive patient in the past 12 months were invited for the interview on their perception of the cardiovascular risk of hypertension,the magnitude of the benefit of antihypertensive drugs, knowledge on the overall risk approach, first-line drugs used, the risk above which drug treatment is recommended, and knowledge on evidence-based medicine.Results A total of 444 of the 468 eligible physicians were successfully interviewed with a response rate of 94.9%. They estimated that a hypertensive man with an actual 5-year cardiovascular risk of 8.4% would have a 5-year cardiovascular risk of 40% （95% CI： 38% to 42%） if not treated, and have an absolute risk reduction and relative risk reduction from drug treatment by 20% （95% CI. 18% to 22%） and 39% （95% CI： 37% to 42%） respectively, as compared to 3.3% and 33%respectively shown in research evidence. On average, the physicians would recommend drug treatment at a number needed to treat （NNT） of 368 or smaller, as compared to the actual NNT of 50 for drug treatment in an average hypertensive Chinese. Fifty-five percent （95% CI： 50% to 59%） of them had never intently used the national hypertension guidelines. The majority still prescribed drugs primarily based on blood pressure alone by ignoring other risk factors or the overall risk and 78% （95 % C/. 76% to 83%） used new expensive drugs such as calcium channel blockers and angiotensin converting enzyme （ACE） inhibitors as first-line treatment. Only 13% （95% CI：9% to 18%） could correctly interpret the NNT. Forty-three percent （95% CI： 39% to 48%） did not know the randomized controlled trial was scientifically the most rigorous among other study designs for evaluating the effectiveness of anti-hypertensive drugs.Ninety-two percent （95% CI： 90% to 94%） did not know they could start by searching systematic reviews when looking for evidence on the effectiveness of anti-hypertensive drugs as opposed to trials. Ninety-six percent （95% CI： 94% to 98%）did not know the Cochrane Library was an important source of systematic reviews.Conclusions The surveyed physicians significantly over-estimated the cardiovascular risk of hypertension and the benefit of drug treatment, and had insufficient knowledge on the overall risk approach. They recommended drug treatment at a cardiovascular risk which was even much lower than the cutoff suggested for western populations, which would make many more people eligible for drug treatment. They also tended to prescribe new expensive drugs although the older cheaper ones may be more appropriate in many patients. They showed inappropriate knowledge on the basics of evidence-based medicine.
基金funded by the Bauhinia Foundation Research Centre,Hong Kong(Ref No.7050162)the data analysis is supported by the primary care comparison study from the Research Grants Committee,Hong Kong(Ref No.CUHK 4002-SPPR-10).
文摘Objective:The recent population census showed China had officially become a graying society.In the meantime,China also faces a growing burden of non-communicable diseases.Since 2009,a series of policies have been implemented to enhance primary care at the community level.This study describes the elderly care services provided in the differently organized community health centers(CHCs).Methods:It covered 13 CHCs of six cities located within the Pearl River Delta(PRD)region.In-depth interviews were conducted with a total of 59 health administrators,CHC managers,and CHC doctors regarding elderly care.Results:The study found that accessibility of healthcare for elders has been improved due to the development of health insurance schemes as well as preferential policy to encourage the CHC utilization by the elderly.All the CHCs provide health examinations and chronic disease management to the permanent elderly within their catchment district.However,some preventative care such as fall prevention,immunization and mental health management are not provided.Conclusion:Key barriers include low capacity of health service providers in the CHCs,and a lack of government investment in CHCs.Our report provides an empirical evidence for the health care reform in China.
