慢性阻塞性肺病在三个低收入和中等收入国家的自我管理:一个试点随机试验
Suzanne L Pollard1,2, Trishul Siddharthan2,3, Shakir Hossen1,2
1Division of Pulmonary and Critical Care.
American journal of respiratory and critical care medicine
|September 12, 2023
概括
社区卫生工作者为慢性阻塞性肺病 (COPD) 自主管理的干预措施并没有改善低资源环境中的患者结果. 为了应对这一全球卫生挑战,需要进一步评估战略.
科学领域:
- 全球健康 全球健康
- 实施科学 实施科学
- 呼吸系统医学 呼吸系统医学
背景情况:
- 慢性阻塞性肺病 (COPD) 在低收入和中等收入国家构成重大负担,压倒现有卫生系统.
- 有效的COPD管理策略至关重要,特别是在资源有限的环境中.
- 正在探索社区卫生工作者 (CHW) 支持模式,以解决医疗保健缺口.
研究的目的:
- 评估CHW支持的中度至重度COPD (等级B-D) 患者的自我管理干预措施的有效性.
- 评估干预对生活质量,恶化和资源贫困环境中的住院治疗的影响.
- 了解尼泊尔,秘鲁和乌干达的实施可行性和结果.
主要方法:
- 进行了一项试点随机现场试验,其中239名参与者被诊断患有COPD等级B-D.
- 参与者被分配到多元组件,CHW支持的干预或COPD教育的标准护理.
- 测量的主要结果是圣乔治呼吸问卷 (SGRQ) 在12个月的得分;次要结果包括恶化和住院.
主要成果:
- 干预组和对照组12个月后的平均总SGRQ得分没有显著差异 (34.7比34.0;P=0.71).
- 与对照组相比,干预组的住院比例较高 (10%对5.2%;P=0.15).
- 干预组 (9%) 的死亡率和随访损失低于对照组 (21%).
结论:
- 基于CHW的COPD恶化自我管理干预措施在资源贫困的环境中没有在一年内证明SGRQ得分有所改善.
- 高准确度和适度的参与表明实施是可行的,但干预的有效性仍然不确定.
- 修订干预策略是必要的,以改善COPD在这些环境中的管理.
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