Effects of secondary prevention clinics on health status in patients with coronary heart disease: 4 year follow-up of a randomized trial in primary care.
Effects of secondary prevention clinics on health status in patients with coronary heart disease: 4 year follow-up of a randomized trial in primary care.
复制标题
二级预防诊所对冠心病患者健康状况的影响：初级保健随机试验的 4 年随访。
作者：
P. Murchie;N. Campbell;L. Ritchie;H. Deans;J. Thain
背景
冠心病疾病管理计划对健康状况的长期影响尚不清楚。在护士主导的二级预防诊所的随机试验中，我们发现一年后健康状况显着改善。四年后再次对参与者进行随访，以确定改善是否持续。
目标
我们的目的是评估初级保健中护士主导的冠心病二级预防诊所对健康的影响。
方法
共有 1343 名冠心病患者被随机分配到护士主导的二级预防诊所或常规护理，并通过回顾医疗病例记录和国家数据集以及邮寄问卷进行 1 年和 4 年的随访。该研究对苏格兰东北部 19 个全科诊所进行了分层随机抽样。健康状况通过 SF-36 问卷测量，胸痛通过心绞痛 TyPE 规范测量，焦虑和抑郁通过医院焦虑和抑郁量表测量。
结果
第一年时，随机分配到诊所的患者的 SF-36 八个领域中的五个（所有功能量表、疼痛和一般健康状况）都有显着改善。因身体问题而导致的角色限制改善最多[调整后差异 8.52，95% 置信区间 (CI) 4.16-12.9]。 4 年时，干预组在所有领域的得分均高于对照组，但差异不再显着。 1 年时，干预组中报告胸痛恶化的患者较少（比值比 0.59，95% C1 0.37-0.94）。 4 年时，干预组或对照组患者在上周报告胸痛或报告胸痛恶化的比例没有显着差异。 1 年或 4 岁时，未观察到对焦虑或抑郁的显着影响。
结论
我们之前已经证明，护士主导的二级预防诊所的参加者的生存率显着提高。尽管如此，研究第一年实现的健康状况改善在第 4 年有所下降。护士主导的诊所的理由仍然很充分，但需要进一步研究如何优化当前的健康状况。
BACKGROUND
The long-term effects of disease management programmes for coronary heart disease on health status are unknown. In a randomized trial of nurse-led secondary prevention clinics, we found significantly improved health status at 1 year. Participants were followed-up again at 4 years to determine if improvements had been sustained.
OBJECTIVE
Our aim was to evaluate the effects on health of nurse-led clinics for the secondary prevention of coronary heart disease in primary care.
METHODS
A total of 1343 patients with coronary heart disease were randomized to nurse-led secondary prevention clinics or usual care, with follow-up at 1 and 4 years by review of medical case notes and national data sets, and postal questionnaires. The study involved a stratified, random sample of 19 general practices in north-east Scotland. Health status was measured by the SF-36 questionnaire, chest pain by the angina TyPE specification and anxiety and depression by the hospital anxiety and depression scale.
RESULTS
At 1 year, there were significant improvements in five of eight SF-36 domains (all functioning scales, pain and general health) in patients randomized to clinics. Role limitations attributed to physical problems improved the most [adjusted difference 8.52, 95% confidence interval (CI) 4.16-12.9]. At 4 years, the intervention group scored higher than control in all domains, but differences were no longer significant. At 1 year, fewer patients in the intervention group reported worsening chest pain (odds ratio 0.59, 95% C1 0.37-0.94). At 4 years, there were no significant differences between the proportion of intervention or control group patients who reported chest pain in the last week or who reported worsening chest pain. No significant effects were observed on anxiety or depression at 1 or 4 years.
CONCLUSION
We have demonstrated previously a significantly greater survival in attendees at nurse-led secondary prevention clinics. Despite this, improvements in health status achieved in the first year of the study were reduced at 4 years. The case for nurse-led clinics remains strong, but further research is required on ways to optimize current health status.