[PP.11.31] THE NECESSITY OF A POPULATION APPROACH IN ACHIEVING HYPERTENSION CONTROL
Notice bibliographique
Résumé
Objective: Globally, the proportion of people with undiagnosed and uncontrolled hypertension is significant. Typically, physician factors such as therapeutic inertia are cited or presumed to underlie a significant proportion of the care gap in hypertension. The objective of this study was to assess the degree to which physician versus system factors contributed to the hypertension treatment gap. Design and method: Data was obtained from the provincial medical database, the national health measures survey, as well as from quality improvement project databases. Because all persons residing in the province are covered under a single health system, it was possible to match databases within specific geographies or patient groups. Results are presented as descriptive or parametric statistics as appropriate. Results: Screening rates for hypertension in primary care for patients who visited a practice were 97%. However, screening rates for persons registered (attached) to a practice were 69%, the care gap being composed of those patients who did not visit a physician during that year. Of those patients treated for hypertension, and who regularly visited a doctor, about 80% achieved blood pressure targets. However, the overall hypertension control rate in the population was in the range of 60–65%, again with this care gap consisting of people who did not regularly see a doctor. Additionally, the greater the attachment and continuity of care with a family doctor, the lower the emergency room visit rate (r = .−64) and the also the greater the specialist availability to primary care, the lower the hospital admission rate (r = .52). When individual practices or clinics were examined via quality improvement initiatives, an identical picture was obtained: those patients who regularly attended a specific doctor/team were much more likely to be diagnosed, treated and controlled than those whose care was sporadic. Conclusions: In order to achieve better hypertension control, focusing on individual physician behavior will likely produce little benefit. Rather, ensuring patients have attachment, access and continuity of care with a doctor/team and that appropriate system (e.g. specialist) support is available for primary care is likely to result in much more benefit to a population.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,083 | 0,040 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».