Opšta Medicina (Jan 2017)
Approach to the patient with metabolic syndrome in general medicine
Abstract
Introduction: Metabolic syndrome (MS) is a collection of metabolic disorders that increase the risk of developing diabetes and cardiovascular disease and is a serious public health problem. Objective: 1. To investigate the approach to the patient with metabolic syndrome in general practice. 2. To find out if the doctors decide independently on pharmacotherapy, or rarely on suggestions of the specialists. Method: The survey was conducted via questionnaire among doctors who attended the training 'Days of general medicine,' in Belgrade. Data about age, sex, length of work in medical practice, working place (city / village) and whether the respondent is a general practitioner (GP) or a general practitioner-specialist (GPS) were obtained. Statistical analysis was done in the statistical program SPSS 11.0 for Windows. Results: The study included 588 subjects, (87.76% women), average age 49.19 ± 9.74 years and an average length of medical practice of 20.74 ± 10.36 years. Majority of doctors (85.20%) worked in the city. Among the respondents there are slightly more GPS (53.91%). For the purpose of diagnosing MS 40.65% of doctors often measured waist to their patients, and 23.98% has never done that. In the diagnosis of abdominal obesity there is no statistically significant difference between GP and GPS (p=0.071), but the doctors with up to 10 years of practice significantly less (p=0.004) measure waist. In order to conduct the laboratory diagnosis of MS, 89.25% of the doctors sought a complete lipidogram and fasting glycemia. As a first and primary therapeutic measure 88.78% of the questioned doctors recommended a change of lifestyle. No statistically significant differences in relation to specialty (p=0.571), length of work (p=0.227) and their position (p=0.180). The largest number of respondents (64.97%) prescribes pharmacotherapy to its patients, a GP significantly more than the GPS (p=0.000) consult a specialist, while GPS more often than general practitioners prescribed treatment to their patients by themselves for all types of metabolic syndrome (p=0.000). In relation to the working experience, doctors with up to 10 years more often send their patients to the consultative examination by specialists (p=0.000); 62.41% of the doctors being questioned prescribed pharmacotherapy to their patients for all kinds of MS, GPS significantly higher (p=0.024). In relation to the working experience, there was no statistically significant difference (p=0.338). Doctors who have examined patients with MS, and sent them to specialists for pharmacotherapy usually (37.04%) stated they considered the treatment of this syndrome as the domain of specialists. Conclusion: Doctors with up to 10 years of work, significantly rarely measure the waist in order to diagnose MS. As a first therapeutical measure, doctors in general medicine recommended a change of lifestyle. GPS frequently prescribe drug therapies for MS and GP doctors and doctors with up to 10 years more often send such patients to the specialists.
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