在社会经济地位较低的患者中改善心脏康复坚持:一项随机临床试验
Diann E Gaalema1,2, Sherrie Khadanga3, Patrick D Savage3
1Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington.
JAMA internal medicine
|July 22, 2024
概括
财政激励和病例管理显著改善了较低社会经济地位 (SES) 的患者的心脏康复坚持. 结合这两种干预措施产生了最好的结果,与通常的护理相比,大幅提高了坚持率.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 心脏康复 (CR) 显著降低了发病率和死亡率.
- 在较低社会经济地位 (SES) 的人口中,CR的利用不足.
- 需要新的干预措施来改善这些群体的CR坚持.
研究的目的:
- 评估早期病例管理和对较低SES患者CR遵守的财政激励措施的有效性.
- 为了确定组合干预措施是否比单个干预措施或通常护理提供更高的坚持率.
主要方法:
- 一项随机临床试验,涉及192名低SES患者,具有合格的心脏诊断.
- 参与者被随机分配到通常的护理,病例管理,财务激励或病例管理和财务激励的组合.
- 通过在1年的随访期间完成至少30次CR疗程的患者比例来衡量坚持.
主要成果:
- 与常规护理相比,所有干预措施都改善了CR的坚持.
- 财政激励 (42%) 和联合干预 (62%) 显示出显著的改善.
- 综合干预措施优于单个干预措施,遵守率为62%.
结论:
- 财政激励,特别是与病例管理相结合时,有效地增加了较低SES患者的心脏康复坚持.
- 这些干预措施得到了很好的欢迎,并显示出对代表性不足的人口群体的显著公共卫生益处.
- 这些发现支持将财务激励和病例管理纳入心脏康复计划.
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