高度な心血管リスクのある低所得高齢者のための広告の原則を用いた自己管理支援:ランダム化制御試験
David J T Campbell1,2,3,4,5, Marcello Tonelli1,2,4,5, Brenda R Hemmelgarn6
1Departments of Community Health Sciences (D.J.T.C., M.T., P.F., J.Z., F.A., J.F., D.V.E., B.J.M.), University of Calgary, Alberta, Canada.
Circulation
|March 5, 2023
まとめ
広告の原則を用いた 調整された自己管理教育と支援 (SMES) プログラムは 低所得の高齢者の心血管疾患を 大幅に減少させました この革新的なアプローチは,高リスク集団における臨床結果の改善に有望です.
科学分野:
- 心血管疾患の研究
- 健康 行動 介入
- 高齢 医学
背景:
- 自己管理教育と支援 (SMES) の介入は,中期的な心血管疾患のアウトカムに控えめな効果を示しています.
- SMESの臨床評価結果の有効性を実証した研究はほとんどありません.
- 広告の原則は,SMEsのデザインで十分に活用されていない.
研究 の 目的:
- 広告の原則を組み込んだ新しい,マッピングされたSMESプログラムを評価する.
- 心血管疾患のリスクが高い高齢者の臨床結果へのプログラムの影響を評価する.
- 生活の質や 薬の服用量や 医療費への影響を調査する
主な方法:
- ランダム化試験では,低所得で心血管疾患のリスクが高い4761人の高齢者が参加した.
- 介入には,健康促進のメッセージと 臨床情報リレーの提供が含まれていました.
- 主なアウトカム:死亡,心筋梗塞,脳卒中,再血管化,心血管疾患による入院.
- 追跡期間中位は36ヶ月; 陰性二項回帰による分析.
主要な成果:
- SMESグループは,プライマリコンポジットアウトカム率 (IRR,0.78;P=0.047) を著しく低下させた.
- 生活の質や 薬の服用量や 医療費の全体的な差は認められませんでした
- SMEsとファクトリアルデザインの別の介入の間には,シネージ効果は認められなかった.
結論:
- 広告の原則を用いた SMES プログラムにより 低所得の高齢者の臨床心血管疾患の 結果が効果的に減少しました
- この改善を促す正確なメカニズムはさらなる調査を必要としています.
- このアプローチは 心血管疾患の管理を強化するための 潜在的な戦略です
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