谁可以从自我管理支持中受益? 来自随机对照试验的结果
Kirstine Skov Benthien1,2, Camilla Palmhøj Nielsen3,4, Knud Rasmussen5
1Palliative Care Unit, Copenhagen University Hospital, Hvidovre, Denmark.
Heliyon
|July 14, 2023
概括
基于电话的自我管理支持改善了生活质量,但增加了医疗保健的使用. 患有糖尿病和多病症的参与者受益最多,尽管过度治疗存在风险.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 慢性疾病管理 慢性疾病管理
- 与健康相关的生活质量 (HRQoL)
背景情况:
- 自主管理支持模型是复杂的干预措施,需要机制评估.
- 一项全国性随机对照试验 (RCT) 评估了基于电话的自我管理支持 (PaHS).
- 干预改善了HRQoL,但没有减少住院病例和增加初级保健使用.
研究的目的:
- 在RCT中确定PAHS干预的影响机制.
- 为了确定哪些患者子组从PaHS中获益最多.
主要方法:
- 相互作用分析检查了调节者 (性别,年龄,教育,慢性病,入院风险,应对) 和调解者 (初级保健联系人,焦虑药物).
- 通过通用线性混合模型分析与健康相关的生活质量 (HRQoL).
- 使用波桑回归分析的入院病例.
主要成果:
- 在入院时,PaHS与糖尿病,多病症,应对和焦虑药物显著相互作用.
- 糖尿病或多病症患者的住院病例减少.
- 在应对能力较强或使用焦虑药物的患者中观察到更多的入院;HRQoL是由性别和糖尿病调解的.
结论:
- 糖尿病患者,多病症患者和妇女可能从电话自主管理支持中获益最多.
- 这种干预存在过度治疗的风险,特别是对于那些应对能力较强或服用焦虑药物的患者.
- 了解干预机制对于优化自我管理支持至关重要.
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