A randomized trial of an intervention to improve use and adherence to effective coronary heart disease prevention strategies.
A randomized trial of an intervention to improve use and adherence to effective coronary heart disease prevention strategies.
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DOI：
10.1186/1472-6963-11-331
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发表时间：
2011-12-05
影响因子：
2.8
通讯作者：
Gizlice Z
中科院分区：
文献类型：
--
作者：
Sheridan SL;Draeger LB;Pignone MP;Keyserling TC;Simpson RJ Jr;Rimer B;Bangdiwala SI;Cai J;Gizlice Z
冠心病(CHD)一级预防的有效策略没有得到充分利用，而且当使用时，依从性低。现有的改进使用和坚持这些有效策略的努力是如此密集，以至于它们在临床实践中是不切实际的。我们在一所大学的普通内科诊所进行了一项CHD预防干预的随机试验(包括计算机化的决策辅助和自动定制的依从性信息)。在获得知情同意并收集基线数据后，我们将患者(年龄40-79岁，无心血管疾病病史的男性和女性)随机分配到干预组或常规护理组。然后，我们在3个月内对他们进行了两次额外的考察访问。对于干预参与者，我们在主要研究访问(基线访问后1周)时执行决策辅助，然后在2、4和6周邮寄3份量身定制的遵守提醒。我们在3个月的随访中评估了两组之间的结果(包括预测的心绞痛、心肌梗死和10年内冠心病死亡的可能性(冠心病风险)和自我报告的依从性)。数据收集发生在2007年6月至2009年12月。所有研究程序都得到了IRB的批准。我们随机选择了160名符合条件的患者(81名干预组，79名对照组)，跟踪调查了96%的患者，以得出研究结论。基线时预测的平均冠心病风险为11.3%。干预将自我报告的对所选降低风险策略的依从性增加了25个百分点(95%可信区间8%至42%)，其中阿司匹林的效果最大。它还将预测的CHD风险改变了-1.1%(95%CI-0.16%至-2%)，对预先指定的高危患者亚组的影响更大。让患者参与CHD决策并支持坚持有效的预防策略的计算机干预可以提高坚持并降低预测的CHD风险。ClinicalTrials.gov：NCT00494052
Efficacious strategies for the primary prevention of coronary heart disease (CHD) are underused, and, when used, have low adherence. Existing efforts to improve use and adherence to these efficacious strategies have been so intensive that they are impractical for clinical practice. We conducted a randomized trial of a CHD prevention intervention (including a computerized decision aid and automated tailored adherence messages) at one university general internal medicine practice. After obtaining informed consent and collecting baseline data, we randomized patients (men and women age 40-79 with no prior history of cardiovascular disease) to either the intervention or usual care. We then saw them for two additional study visits over 3 months. For intervention participants, we administered the decision aid at the primary study visit (1 week after baseline visit) and then mailed 3 tailored adherence reminders at 2, 4, and 6 weeks. We assessed our outcomes (including the predicted likelihood of angina, myocardial infarction, and CHD death over 10 years (CHD risk) and self-reported adherence) between groups at 3 month follow-up. Data collection occurred from June 2007 through December 2009. All study procedures were IRB approved. We randomized 160 eligible patients (81 intervention; 79 control) and followed 96% to study conclusion. Mean predicted CHD risk at baseline was 11.3%. The intervention increased self-reported adherence to chosen risk reducing strategies by 25 percentage points (95% CI 8% to 42%), with the biggest effect for aspirin. It also changed predicted CHD risk by -1.1% (95% CI -0.16% to -2%), with a larger effect in a pre-specified subgroup of high risk patients. A computerized intervention that involves patients in CHD decision making and supports adherence to effective prevention strategies can improve adherence and reduce predicted CHD risk. ClinicalTrials.gov: NCT00494052
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影响因子：
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通讯作者：
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