The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers.
The Office Guidelines Applied to Practice program improves secondary prevention of heart disease in Federally Qualified Healthcare Centers.
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DOI：
10.1016/j.pmedr.2016.06.020
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发表时间：
2016-12
影响因子：
2.8
通讯作者：
Holmes-Rovner M
中科院分区：
文献类型：
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作者：
Olomu A;Khan NN;Todem D;Huang Q;Kumar E;Holmes-Rovner M
少数族裔和低收入人群的心血管疾病（CVD）负担是有据可查的。本研究旨在通过联邦合格医疗中心 (FQHC) 的实践应用办公室指南 (Office-GAP) 干预来评估患者激活和共同决策 (SDM) 对药物使用的影响。 2010 年 10 月至 2014 年 3 月期间，患有糖尿病和先心病的患者 (243 名) 参加了 Office-GAP。两点 (FQHC) 干预/对照设计。 Office-GAP 将健康素养、患者和医生的沟通技巧教育、决策支持工具和 SDM 整合到日常护理中。主要衡量指标：1) 实施率，2) 基线、3、6 和 12 个月的药物使用情况，以及 3) 药物使用的预测因素。带有倾向评分的逻辑回归评估了对药物使用的影响。干预组有 120 名患者，对照组有 123 名患者。我们发现程序元素的使用是一致的。与对照相比，Office-GAP 计划较基线显着改善了药物使用：3 个月（OR 1.88，95% CI = 1.07；3.30，p < 0.03）、6 个月（OR 2.68，95% CI = 1.58；4.54；p < 0.01）、6 个月（OR 2.68，95% CI = 1.58；4.54；p < 0.01）；他汀类药物 3 个月（OR 2.00，95% CI = 0.1.22；3.27；p < 0.05）、6 个月（OR 3.05，95% CI = 1.72；5.43；p < 0.01），阿司匹林和/或氯吡格雷 3 个月 OR 1.59，95% CI = 1.02, 2.48； p < 0.05），6 个月（OR 3.67，95% CI = 1.67；8.08；p < 0.01）。仅通过 Office-GAP 干预的存在和高血压来预测总体药物依从性。 Office-GAP 导致服务不足的人群更多地使用基于指南的药物来进行二级 CVD 预防。 Office-GAP 计划可以作为对其他慢性病实施基于指南的护理的模式。 Office-GAP 干预预测了 FQHC 中的整体用药依从性。该计划改善了糖尿病患者对 ACEI/ARB、他汀类药物和阿司匹林的使用。年龄较大、女性和黑人种族预测了他汀类药物的使用。 Office-GAP 可以作为实施慢性病指南的模型。
The burden of cardiovascular disease (CVD) among minority and low-income populations is well documented. This study aimed to assess the impact of patient activation and shared decision-making (SDM) on medication use through the Office-Guidelines Applied to Practice (Office-GAP) intervention in Federally Qualified Healthcare Centers (FQHCs). Patients (243) with diabetes and CHD participated in Office-GAP between October 2010 and March 2014. Two-site (FQHCs) intervention/control design. Office-GAP integrates health literacy, communication skills education for patients and physicians, decision support tools, and SDM into routine care. Main measures: 1) implementation rates, 2) medication use at baseline, 3, 6, and 12 months, and 3) predictors of medication use. Logistic regression with propensity scoring assessed impact on medication use. Intervention arm had 120 and control arm had 123 patients. We found that program elements were consistently used. Compared to control, the Office-GAP program significantly improved medications use from baseline: ACEIs or ARBs at 3 months (OR 1.88, 95% CI = 1.07; 3.30, p < 0.03), 6 months (OR 2.68, 95% CI = 1.58;4.54; p < 0.01); statin at 3 months (OR 2.00, 95% CI = 0.1.22; 3.27; p < 0.05), 6 months (OR 3.05, 95% CI = 1.72; 5.43; p < 0.01), Aspirin and/or clopidogrel at 3 months OR 1.59, 95% CI = 1.02, 2.48; p < 0.05), 6 months (OR 3.67, 95% CI = 1.67; 8.08; p < 0.01). Global medication adherence was predicted only by Office-GAP intervention presence and hypertension. Office-GAP resulted in increased use of guideline-based medications for secondary CVD prevention in underserved populations. The Office-GAP program could serve as a model for implementing guideline-based care for other chronic diseases. Office-GAP intervention predicted global medication adherence in FQHCs. The Program improved use of ACEI/ARBs, statin and Aspirin in diabetics. Older age, female gender and black race predicted the use of statin. Office-GAP could serve as a model for implementing guidelines for chronic diseases.