The Impact Of Health Education On Physicians’ Screening Of Glucose Metabolism For Hypertensive Outpatients

Quite a number of hypertensive patients were with other cardiovascular diseases risk factors, of which abnormal glucose metabolism is of concern. Compared with those who were only hypertensive, the patients with hypertension and abnormal glucose metabolism have a high risks for developing cardiovascular diseases in the following years. The hypothesis of the present study is that education for cardiologists regarding the abnormal glucose metabolism can increase the prescription rate of oral glucose tolerance test (OGTT) for hypertensive patients.Part I:Abstract for the Baseline InvestigationAims:To investigate the OGTT prescription rate for hypertensive outpatients, and to explore the related factors of OGTT prescription.Methods:In March2010, we recruited524cardiologists that met the inclusion criteria according to the location and hospital class with258cardiologists in the controlled group and266cardiologists in the intervention group. Then the special investigators would interview the hypertensive patients who were recruited consecutively by the cardiologists. Multiple logistic regression models were used to determine the factors affecting the OGTT prescription.Results:Of the5240hypertensive outpatients,258(4.92%) underwent OGTT prescription, with133(5.16%) for the controlled group and125(4.70%) for the intervention group respectively (P=0.4458). Of the258patients who were prescribed OGTT,98(42.61%) were diagnosed with impaired glucose tolerance (IGT), and28were diagnosed with diabetes mellitus (DM), and104were with normal glucose status (45.22%). Those with cardiovascular diseases, diabetes mellitus family history, and dyslipidemia had a high possibility to be prescribed OGTT with odds ratios (OR) and corresponding95%confidence intervals (CIs) of1.85(1.39,2.47)、1.90(1.42,2.54), and2.43(1.86,3.16). The OR and95%CI to be prescribed OGTT for those who went to Class III hospitals were1.60(1.16,2.20).Conclusion:The OGTT prescription rate was relatively low in Chinese hypertensive outpatients, and abnormal glucose metabolism was prevalent among those who underwent OGTT. Cardiovascular diseases, diabetes mellitus family history, and dyslipidemia were associated with OGTT prescription.Part Ⅱ:Abstract for the Follow-up StudyAims:To evaluate the impacts of education program on OGTT prescription for hypertensive outpatients.Methods:The cohort of baseline cardiologists were followed up in the present study. Each cardiologists would recruit10hypertensive patients that met the inclusion criteria consecutively. Special investigators would record the prescriptions of the patients. Log Binomial regression models were used to evaluate the education impacts. Covariates in the models included group, follow-up time, gender, age, health insurance, hospital class, diabetes mellitus family history, hypertension family history, abdominal obesity. We also examined the interaction effects between group and diabetes mellitus family history, group and hypertension family history, group and abdominal obesity.Results:Of the524cardiologists at the baseline,510(97.33%) were followed up at the present study with247(95.74%) in controlled group and263(98.87%) in the education group (P=0.7960). The OGTT prescription rate was13.56%and15.29%in the controlled group and education group respectively (P=0.0804). We found significant difference between controlled group and education group regarding OGTT prescription rate in those with diabetes family history (7.83%and12.77%), hypertension family history (18.49%and28.02%), and abdominal obesity (10.53%and13.95%). After adjusting follow-up time, gender, age, health insurance, and hospital class, the interaction effects between group and diabetes mellitus family history, group and hypertension family history, group and abdominal obesity existed. The cardiologists in the education group were prone to prescribe more OGTT to those with diabetes mellitus family history, hypertension history, and abdominal obesity with RRs of1.24,1.53, and1.41.Conclusions:The education program for cardiologists could not increase the OGTT prescription rate significantly, while it can increased the OGTT prescription rate for patients with diabetes family history, hypertension history, and abdominal obesity.