Impact of a patient decision aid on care among patients with nonvalvular atrial fibrillation: a cluster randomized trial
Impact of a patient decision aid on care among patients with nonvalvular atrial fibrillation: a cluster randomized trial
复制标题
DOI：
10.1503/cmaj.050091
复制
发表时间：
2005-08-30
影响因子：
14.6
通讯作者：
Fradette, M
中科院分区：
文献类型：
--
作者：
McAlister, FA;Man-Son-Hing, M;Fradette, M
背景：很少有非瓣膜性心房颤动（NVAF）患者接受适当的抗血栓治疗。我们测试了短期（主要结局）和长期（次要结局）患者决策辅助对非瓣膜性房颤患者抗栓治疗的适宜性的影响。方法：我们进行了一项分组随机试验，对来自102个社区基础初级保健机构的434名非瓣膜性房颤患者进行了盲法结果评估。干预组的患者收到了一份自我管理的小册子和录音带，根据他们的个人中风风险概况进行决策辅助。对照组患者接受常规治疗。主要结局指标是3个月时抗血栓治疗的变化。治疗的适当性是根据美国胸科医师学会（ACCP）的建议来确定的。结果：患者平均年龄为72岁，非瓣膜性房颤的中位病程为5年。在对照组中，3个月内接受与其卒中风险相适应的治疗的患者数量减少了3%（基线时为40%[85/ 215]，3个月时为37%[79/ 215]）。在干预组中，接受适合其卒中风险的治疗的患者数量增加了9%（基线时为32%[69/ 219]，3个月时为41%[89/ 219]）。尽管在基线（p = 0.11）和3个月（p = 0.44）时，两组患者接受ACCP治疗建议的比例没有差异，但在3个月时，与对照组相比，干预组接受适当治疗的患者数量有12%的绝对改善（p = 0.03）。辅助决策的有益效果并没有持续（12个月后各组之间的差异p = 0.44）。解释：在接受辅助决策治疗的非瓣膜性房颤患者中，抗血栓治疗的适当性有短期改善，但这种改善并没有持续下去。
Background: Too few patients with nonvalvular atrial fibrillation ( NVAF) receive appropriate antithrombotic therapy. We tested the short- term ( primary outcome) and long- term ( secondary outcome) effect of a patient decision aid on the appropriateness of antithrombotic therapy among patients with NVAF.Methods: We conducted a cluster randomized trial with blinded outcome assessment involving 434 NVAF patients from 102 community- based primary care practices. Patients in the intervention group received a self- administered booklet and audiotape decision aid tailored to their personal stroke risk profile. Patients in the control group received usual care. The primary outcome measure was change in antithrombotic therapy at 3 months. Appropriateness of therapy was defined using the American College of Chest Physicians ( ACCP) recommendations.Results: The mean patient age was 72 years, and the median duration of NVAF was 5 years. In the control group, there was a 3% decrease over 3 months in the number of patients receiving therapy appropriate to their risk of stroke ( 40% [ 85/ 215] at baseline v. 37% [ 79/ 215] at 3 months). In the intervention group, the number of patients receiving therapy appropriate to their stroke risk increased by 9% ( 32% [ 69/ 219] at baseline v. 41% [ 89/ 219] at 3 months). Although the proportion of patients whose therapy met the ACCP treatment recommendations did not differ between study arms at baseline ( p = 0.11) or 3 months ( p = 0.44), there was a 12% absolute improvement in the number of patients receiving appropriate care in the intervention group compared with the control group at 3 months ( p = 0.03). The beneficial effect of the decision aid did not persist ( p = 0.44 for differences between study arms after 12 months).Interpretation: There was short- term improvement in the appropriateness of antithrombotic care among patients with NVAF who were exposed to a decision aid, but the improvement did not persist.