Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial.
Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial.
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DOI：
10.7326/m16-1245
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发表时间：
2017-03-21
影响因子：
39.2
通讯作者：
Dolor RJ
中科院分区：
文献类型：
--
作者：
Allen KD;Oddone EZ;Coffman CJ;Jeffreys AS;Bosworth HB;Chatterjee R;McDuffie J;Strauss JL;Yancy WS Jr;Datta SK;Corsino L;Dolor RJ
一项单中心研究表明，患者和提供者的联合干预改善了膝关节骨关节炎患者的结局，但没有评估干预的单独效果。检查以患者为基础、以提供者为基础和患者-提供者干预是否改善骨关节炎结局。分组为患者、提供者和患者-提供者干预或常规护理的整群随机试验。（ClinicalTrials.gov：）10个杜克大学卫生系统社区初级保健诊所。537例有症状的髋关节或膝关节骨关节炎门诊患者。基于电话的患者干预集中在体重管理，体力活动和认知行为疼痛管理。提供者干预涉及向提供者电子交付患者特定的骨关节炎治疗建议。主要结局是12个月时的西安大略和麦克马斯特大学骨关节炎指数（WOMAC）总分。次要结局为客观身体功能（短期身体机能成套测验）和抑郁症状（患者健康问卷）。线性混合模型评估组间改善的差异。患者的WOMAC评分从基线至12个月的变化无差异（-1.5 [95% CI，-5.1至2.0]; P = 0.40），供应商（2.5 [CI，-0.9至5.9]; P = 0.152）或患者-提供者（-0.7 [CI，-4.2至2.8]; P = 0.69）干预组与常规护理相比。所有组在12个月时的WOMAC评分均有所改善（范围，-3.7至-7.7）。此外，与常规护理相比，任何干预组在12个月时的客观身体功能或抑郁症状均无差异。该研究涉及1个医疗保健网络。没有收集关于提供者转诊的数据。与之前在退伍军人事务部医疗中心对骨关节炎患者和提供者联合干预的研究相反，这项研究发现，与常规护理相比，骨关节炎干预组没有统计学显著改善。国家关节炎、肌肉骨骼和皮肤病研究所。
A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions. To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes. Cluster randomized trial with assignment to patient, provider, and patient-provider interventions or usual care. (ClinicalTrials.gov: ) 10 Duke University Health System community-based primary care clinics. 537 outpatients with symptomatic hip or knee osteoarthritis. The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups. No difference was observed in WOMAC score changes from baseline to 12 months in the patient ( –1.5 [95% CI, –5.1 to 2.0]; P = 0.40), provider (2.5 [CI, –0.9 to 5.9]; P = 0.152), or patient-provider ( –0.7 [CI, –4.2 to 2.8]; P = 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, –3.7 to –7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care. The study involved 1 health care network. Data on provider referrals were not collected. Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically significant improvements in the osteoarthritis intervention groups compared with usual care. National Institute of Arthritis and Musculoskeletal and Skin Diseases.