Telemedicine-supported transition of stable coronary artery disease patients from tertiary to primary health care facilities: protocol for a randomized non-inferiority trial.
Telemedicine-supported transition of stable coronary artery disease patients from tertiary to primary health care facilities: protocol for a randomized non-inferiority trial.
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DOI：
10.1186/s12913-016-1469-4
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发表时间：
2016-07-07
影响因子：
2.8
通讯作者：
Polanczyk CA
中科院分区：
文献类型：
--
作者：
Batista Jd;Furtado MV;Katz N;Agostinho MR;Neto BS;Harzheim E;Polanczyk CA
在三级转诊诊所接受治疗的许多患有复杂疾病的巴西患者长期稳定。这些患者的主要需求包括监测危险因素和审查药物处方，这些都可以在初级保健设施中令人满意地完成。该协议的目标是评估远程医疗服务的安全性和有效性，以支持稳定性慢性冠状动脉疾病患者从三级护理过渡到一级护理。我们设计了一项随机的非自卑方案，将包括280名稳定性冠状动脉疾病患者(持续至少12个月)。患者将从巴西南部一家三级护理医院的缺血性心脏病诊所挑选出来。登记的参与者将被随机分为两组：在同一家诊所进行12个月的随访；或在初级保健机构进行12个月的随访，并得到远程医疗平台的临床支持，包括医生免费电话(干预组)。在干预组，在随访期间将患者转介到三级护理的决定将由初级医生和医疗远程会诊共同做出。两组将在主要结果方面进行比较-12个月后维持基线功能1级或2级。次要结果包括风险因素的控制和疾病的不稳定。我们打算确定使用远程医疗来使慢性冠状动脉疾病患者从三级护理过渡到初级护理的有效性。这应有助于患者获得医疗保健系统，因为医疗服务将提供离他们家更近的地方，并为往往过于拥挤的三级护理医院的重症患者提供更多治疗机会。ClinicalTrials.gov#NCT02489565-试验注册日期2015年5月13日
Many Brazilian patients with complex diseases who are treated in tertiary referral clinics have been stable for long periods. The main needs of these patients involve monitoring of risk factors and review of drug prescriptions, which could be satisfactorily done in primary care facilities. The goal of this protocol is to evaluate the safety and effectiveness of telemedicine services to support the transition of patients with stable chronic coronary artery disease from the tertiary to the primary level of care. We designed a randomized non-inferiority protocol that will include 280 patients with stable coronary artery disease (for at least 12 months). Patients will be selected from the Ischemic Heart Disease Clinic in a tertiary care hospital in southern Brazil. Enrolled participants will be randomized into one of two groups: 12 months of follow-up at the same clinic; or 12 months of follow-up at a primary care facility with clinical support from a telemedicine platform including a toll-free line for physicians (intervention group). In the intervention group, decisions to refer patients to tertiary care during follow-up will be made jointly by primary physicians and medical teleconsultants. The groups will be compared in terms of the primary outcome—maintenance of baseline functional class 1 or 2 after 12 months. Secondary outcomes include control of risk factors and instability of the disease. We intend to determine the effectiveness of using telemedicine to qualify the transition of patients with chronic coronary disease from the tertiary to the primary level of care. This should facilitate the access of patients to the healthcare system, since care will be provided closer to their homes, and provide more opportunities for treatment of severe cases at tertiary care hospitals that are often overcrowded. ClinicalTrials.gov # NCT02489565 – trial registration date May 13, 2015