An Informed and Activated Patient: Addressing Barriers in the Pathway From Education to Outcomes.
An Informed and Activated Patient: Addressing Barriers in the Pathway From Education to Outcomes.
复制标题
知情且积极主动的患者：解决从教育到结果的道路上的障碍。
DOI：
10.1053/j.ajkd.2015.09.017
复制
发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Fagerlin,Angela
中科院分区：
文献类型：
--
作者：
WrightNunes,JulieA;Cavanaugh,KerriL;Fagerlin,Angela
我们需要做得更好，帮助人们管理他们复杂的健康状况。数据表明，慢性肾脏病（CKD）患者的健康和正规教育之间存在重要联系。1识字率低和正规教育较少与肾脏疾病的更严重阶段，肾脏特异性知识较少和发病率增加有关。1-3然而，我们对教育程度和健康之间的因果机制的理解受到观察性横断面研究设计的限制。有一个关键的和未满足的需要，以确定因果机制的途径，从教育到健康状况不佳，并确定这些机制是否是不同的CKD相比，其他条件。当我们理解了这一途径的因果机制后，我们就可以专注于解决那些阻止患者采取必要措施保持健康和保护肾功能的可改变的障碍。在这期AJKD中，Morton等人4报告了对参加SHARP（心脏和肾脏保护研究5）的6,000多名CKD患者的事后分析。作者确定了4%未接受过正规教育的参与者与11%接受过最高教育（高等教育）的参考组之间血管发病率和病因特异性死亡率的显著差异。在整个研究人群中，观察到死亡率的点估计值呈渐进趋势，但尽管样本量很大，但相邻教育程度组之间的差异在统计学上并不显著。此外，在调整生活方式因素（如吸烟状况和合并症）后，与较低教育程度相关的过度死亡风险大大降低甚至消除。有趣的是，研究人员没有发现不同教育水平的CKD进展率存在差异。
We need to do a better job helping people manage their complex health conditions. Data suggest there is an important link between health and formal education in patients with chronic kidney disease (CKD). 1 Low literacy and less formal education are associated with more severe stages of kidney disease, less kidney-specific knowledge, and increased morbidity. 1–3 However, our understanding of causal mechanisms in the pathway between educational attainment and health is limited by observational cross-sectional study designs. There is a critical and unmet need to identify causal mechanisms in the pathway from education to poor health and determine whether these mechanisms are different in CKD compared with other conditions. When we understand causal mechanisms in the pathway, we can focus on addressing modifiable barriers that prevent patients from taking the necessary steps to stay healthy and preserve kidney function.In this issue of AJKD, Morton et al4 report on a post hoc analysis of more than 6,000 patients with CKD participating in SHARP (Study of Heart and Renal Protection5). The authors identified significant differences in vascular morbidity and cause-specific mortality between the 4% of participants who had no formal education and a referent group comprising the 11% who had highest educational attainment (tertiary education). Across the study population, a progressive trend in point estimates was observed for mortality, but the differences between neighboring educational attainment groups were not statistically significant despite the large sample size. Also, after adjustment for lifestyle factors such as smoking status and comorbid conditions, the excess mortality risk associated with lower educational attainment was considerably reduced or even eliminated. Interestingly, the researchers did not find a difference in CKD progression rates across education levels.