A heart failure self-management program for patients of all literacy levels: a randomized, controlled trial [ISRCTN11535170].
A heart failure self-management program for patients of all literacy levels: a randomized, controlled trial [ISRCTN11535170].
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DOI：
10.1186/1472-6963-6-30
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发表时间：
2006-03-13
影响因子：
2.8
通讯作者：
Pignone MP
中科院分区：
文献类型：
--
作者：
DeWalt DA;Malone RM;Bryant ME;Kosnar MC;Corr KE;Rothman RL;Sueta CA;Pignone MP
心力衰竭患者的自我管理计划可以减少住院和死亡率。然而，还没有程序分析它们对识字率低的患者的有用性。我们比较了为低识字率患者设计的心力衰竭自我管理计划与常规护理的疗效。我们进行了为期12个月的随机对照试验。从2001年11月到2003年4月，我们招募了30-80岁的受试者，他们患有心力衰竭并服用速尿。干预患者接受自我护理教育，重点是日常体重测量、利尿剂剂量自我调整、症状识别和反应。提供了以图片为基础的教育材料、电子秤和预定的电话跟踪，以加强遵守。对照组患者接受普通心力衰竭手册和常规护理。主要结果是合并住院或死亡，以及心力衰竭相关的生活质量。123例患者(对照组，59例干预)，41%的患者文化程度不高。干预组患者的住院率和病死率较低(粗发病率比(IRR)=0.69；CI为0.4，1.2；调整后的IRR=0.53；CI为0.32，0.89)。低识字率患者(IRR=0.39；CI 0.16，0.91)的差异大于高识字率患者(IRR=0.56；CI 0.3，1.04)，但交互作用无统计学意义。在12个月时，干预组中更多的患者报告每天监测体重(79%比29%，p<；0.0001)。在调整了基线人口统计和治疗差异后，我们发现12个月时心力衰竭相关生活质量没有差异(差异=-2；CI-5，+9)。为识字率低的患者设计的基于初级保健的心力衰竭自我管理计划降低了住院或死亡的风险。
Self-management programs for patients with heart failure can reduce hospitalizations and mortality. However, no programs have analyzed their usefulness for patients with low literacy. We compared the efficacy of a heart failure self-management program designed for patients with low literacy versus usual care. We performed a 12-month randomized controlled trial. From November 2001 to April 2003, we enrolled participants aged 30–80, who had heart failure and took furosemide. Intervention patients received education on self-care emphasizing daily weight measurement, diuretic dose self-adjustment, and symptom recognition and response. Picture-based educational materials, a digital scale, and scheduled telephone follow-up were provided to reinforce adherence. Control patients received a generic heart failure brochure and usual care. Primary outcomes were combined hospitalization or death, and heart failure-related quality of life. 123 patients (64 control, 59 intervention) participated; 41% had inadequate literacy. Patients in the intervention group had a lower rate of hospitalization or death (crude incidence rate ratio (IRR) = 0.69; CI 0.4, 1.2; adjusted IRR = 0.53; CI 0.32, 0.89). This difference was larger for patients with low literacy (IRR = 0.39; CI 0.16, 0.91) than for higher literacy (IRR = 0.56; CI 0.3, 1.04), but the interaction was not statistically significant. At 12 months, more patients in the intervention group reported monitoring weights daily (79% vs. 29%, p < 0.0001). After adjusting for baseline demographic and treatment differences, we found no difference in heart failure-related quality of life at 12 months (difference = -2; CI -5, +9). A primary care-based heart failure self-management program designed for patients with low literacy reduces the risk of hospitalizations or death.
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影响因子：
6.1
作者：
VUONG, QH
通讯作者：
VUONG, QH
影响因子：
--
作者：
Schillinger, D;Piette, J;Bindman, AB
通讯作者：
Bindman, AB
影响因子：
5.7
作者：
Baker, DW;Parker, RM;Clark, WS
通讯作者：
Clark, WS
影响因子：
--
作者：
Krumholz, HM;Parent, EM;Hennen, J
通讯作者：
Hennen, J
影响因子：
3
作者：
Harrison, MB;Browne, GB;Graham, ID
通讯作者：
Graham, ID