Oosterveld, B. (Berdien) (2017) Het effect van de CVRM zorgstraat op de bloeddruk en het lipidenspectrum van patiënten in de huisartsenpraktijk. thesis, Medicine.
Full text available on request.Abstract
Background and purpose Cardiovascular diseases (CVDs) are diseases that lead to high morbidity and mortality rates and increasing healthcare expenses in The Netherlands. In the past years, several guidelines have been developed for the prevention of CVDs by general practitioners. The current guideline on Cardiovascular Risk Management (CVRM) provides advice regarding the use of medicinal and non-medicinal therapies in patients on the basis of the estimated risk of suffering or dying from CVDs. However, general practitioners have doubts about the effectiveness of CVRM care. These doubts are also present in literature from previous studies. The aim of this study is to analyse the effect of CVRM care on the blood pressure and lipid profile of patients in a primary care setting. Methods In a retrospective cohort study with data collected from de General Practitioner Information system, blood pressure data from 794 patients and cholesterol data from 955 patients included in CVRM care were analysed from the moment of inclusion during 5 years of follow-up. In addition, the baseline factors that influence the changes in blood pressure and cholesterol were analysed. Furthermore, the proportion of patients with a Systolic Blood Pressure (SBP) and LDL-cholesterol values below the target value (SBP<140 mmHg and LDL-cholesterol<2.5 mmol/l) was calculated for each calendar year. Results The results showed the largest change compared to the moment of inclusion after 5 years of follow-up, with a decline of 3.83 mmHg of the diastolic blood pressure (DBP), 7.63 mmHg of the SBP, 0.20 mmol/l of the LDL-cholesterol and 0.23 mmol/l of the total cholesterol with a significant change in each follow-up year. Changes in HDL-cholesterol were not significant and the triglyceride values only showed significant changes in follow-up year 4 and 5. The baseline factors with a significant influence on these changes were mainly the risk score and parts of the risk score (age and smoking status), wherein a larger decline of blood pressure or lipids was seen in patients with a higher risk score, an older age or a positive smoking status. The proportion of patients with values below the target value increased from 39.5% to 63.8% for SBP and from 15.3% to 40.5% for LDL-cholesterol between 2006 and 2016. Conclusion This study shows that the CVRM care is effective when looking at decreasing blood pressure and lipid levels. The largest decline is seen in patients with a high risk of suffering or dying from CVDs. During the past years, the proportion of patients with SBP and LDL-cholesterol values below the target value has increased, which might be due to improvements in CVRM care.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultaire begeleider: and Palen, Prof. Dr. J. van der |
| Supervisor name: | Tweede begeleider: and Lugt, Drs. P. van der and Locatie: HOED De Esch, Haaksbergen and Uitgevoerd in opdracht van de Twentse Huisartsenonderneming |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:04 |
| Last Modified: | 25 Jun 2020 11:04 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2396 |
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