多站点随机试验,针对心力衰竭患者的单次 vs 多次会话识字敏感自我护理干预
Darren A DeWalt1, Dean Schillinger, Bernice Ruo
1Division of General Internal Medicine, University of North Carolina School of Medicine, 5041 Old Clinic Bldg, CB#7110, Chapel Hill, NC 27599, USA. dewaltd@med.unc.edu
Circulation
|May 11, 2012
概括
对心力衰竭 (HF) 患者进行密集的自我护理培训并没有改善整体结果. 然而,多会话干预显著有利于低识字率的患者,减少住院和死亡.
科学领域:
- 心脏病学 心脏病学
- 卫生识字 卫生识字
- 患者教育 患者教育
背景情况:
- 自我护理培训对于管理心力衰竭 (HF) 和减少住院治疗至关重要.
- 弱势群体,如识字能力较低的个体,可能需要更密集的干预.
- 了解量身定制的教育方法对HF患者结果的影响至关重要.
研究的目的:
- 为了比较单次疗程与多次疗程自我护理培训干预治疗心力衰竭 (HF) 患者的有效性.
- 评估识字水平对强化高压自我护理干预措施有效性的影响.
- 评估不同干预强度对HF患者临床结果和生活质量的影响.
主要方法:
- 一年多的多站点随机对照试验,涉及605名患有HF的患者.
- 干预包括40分钟的识字敏感单一会议或同一个会议加上持续的电话支持 (多次会议).
- 主要结局:所有原因住院或死亡的综合发病率. 二次结果:与HF相关的住院治疗和生活质量,按识字程度分层.
主要成果:
- 总体而言,单疗程和多疗程组之间的全因住院或死亡没有显著差异.
- 识字能力较低的患者在多次训练 (IRR 0.75) 的情况下,出现了较低住院/死亡率的趋势.
- 读写能力较高的患者在多次训练中呈现出更高住院/死亡率的趋势 (IRR 1.22),与读写能力有显著的相互作用 (P=0.048).
结论:
- 与单次训练相比,密集的多会话自我护理干预措施并没有改善心力衰竭患者的整体临床结果.
- 识字能力较低的患者似乎比识字能力较高的患者从多会话干预中获得更大的益处.
- 根据患者的识字水平量身定制自我护理干预措施可能对优化心力衰竭管理结果至关重要.
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