An eHealth Diary and Symptom-Tracking Tool Combined With Person-Centered Care for Improving Self-Efficacy After a Diagnosis of Acute Coronary Syndrome: A Substudy of a Randomized Controlled Trial
An eHealth Diary and Symptom-Tracking Tool Combined With Person-Centered Care for Improving Self-Efficacy After a Diagnosis of Acute Coronary Syndrome: A Substudy of a Randomized Controlled Trial
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电子健康日记和症状跟踪工具与以人为本的护理相结合，可提高急性冠脉综合征诊断后的自我效能：随机对照试验的子研究
DOI：
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发表时间：
2016
影响因子：
7.4
通讯作者：
I. Ekman
中科院分区：
文献类型：
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作者：
A. Wolf;A. Fors;K. Ulin;J. Thorn;K. Swedberg;I. Ekman
背景心血管疾病患者采用以人为本的护理（PCC）方法进行管理，已被观察到比传统护理有更好的治疗效果和满意度。电子健康可以促进往往缓慢过渡到更多的人为中心的医疗保健，通过增加病人的信念，在自己的能力（自我效能），以管理他们的护理轨迹。电子健康正在越来越多地使用，但大多数研究仍然集中在医疗保健专业人员的护理逻辑。缺乏关于电子健康工具与PCC结合对慢性心脏病患者自我效能的影响的知识。目的探讨电子健康日记和心电图追踪工具结合PCC对急性冠脉综合征（ACS）患者的治疗效果。方法本研究是一项随机对照试验的子研究，旨在研究PCC在ACS住院患者中的作用。共有199例年龄<75岁的ACS患者被随机分配到PCC干预组（n=94）或标准治疗组（对照组，n=105），并随访6个月。干预组的患者可以选择在出院后至少2个月内使用基于网络或基于移动设备的电子健康工具，或两者兼而有之。主要终点是一般自我效能、恢复工作或先前活动水平以及出院后6个月再住院或死亡的变化的综合评分。在干预组的94名患者中，37名（39%）在指数住院后至少使用过一次电子健康工具。其中大多数（24/37，65%）使用移动的应用程序，而不是基于Web的应用程序作为每日自我评价输入的主要来源。患者在前8周内平均使用电子健康工具38次（范围1-118，SD 33），在6个月内平均使用64次（范围1-597，SD 104）。与对照组相比，使用eHealth工具联合PCC干预的患者的主要终点改善了4倍（比值比4.0，95% CI 1.5-10.5; P= 0.005）。与对照组相比，这种改善是由一般自我效能感的显著增加驱动的（P=.011）。未使用电子健康工具的PCC组患者（n=57）与对照组患者（n=105）相比，复合评分改善不显著（比值比2.0，95% CI 0.8-5.2; P= 0.14）。结论我们发现，与传统护理相比，使用电子健康日记和跟踪工具结合PCC对改善患者的一般自我效能感和综合评分有显着效果。试验注册瑞典注册中心，Researchweb.org，ID NR 65 791。
Background Patients with cardiovascular diseases managed by a person-centered care (PCC) approach have been observed to have better treatment outcomes and satisfaction than with traditional care. eHealth may facilitate the often slow transition to more person-centered health care by increasing patients’ beliefs in their own capacities (self-efficacy) to manage their care trajectory. eHealth is being increasingly used, but most studies continue to focus on health care professionals’ logic of care. Knowledge is lacking regarding the effects of an eHealth tool on self-efficacy when combined with PCC for patients with chronic heart diseases. Objective The objective of our study was to investigate the effect of an eHealth diary and symptom-tracking tool in combination with PCC for patients with acute coronary syndrome (ACS). Methods This was a substudy of a randomized controlled trial investigating the effects of PCC in patients hospitalized with ACS. In total, 199 patients with ACS aged <75 years were randomly assigned to a PCC intervention (n=94) or standard treatment (control group, n=105) and were followed up for 6 months. Patients in the intervention arm could choose to use a Web-based or mobile-based eHealth tool, or both, for at least 2 months after hospital discharge. The primary end point was a composite score of changes in general self-efficacy, return to work or prior activity level, and rehospitalization or death 6 months after discharge. Results Of the 94 patients in the intervention arm, 37 (39%) used the eHealth tool at least once after the index hospitalization. Most of these (24/37, 65%) used the mobile app and not the Web-based app as the primary source of daily self-rating input. Patients used the eHealth tool a mean of 38 times during the first 8 weeks (range 1–118, SD 33) and 64 times over a 6-month period (range 1–597, SD 104). Patients who used the eHealth tool in combination with the PCC intervention had a 4-fold improvement in the primary end point compared with the control group (odds ratio 4.0, 95% CI 1.5–10.5; P=.005). This improvement was driven by a significant increase in general self-efficacy compared with the control group (P=.011). Patients in the PCC group who did not use the eHealth tool (n=57) showed a nonsignificant composite score improvement compared with those in the control group (n=105) (odds ratio 2.0, 95% CI 0.8–5.2; P=.14). Conclusions We found a significant effect on improved general self-efficacy and the composite score for patients using an eHealth diary and symptom-tracking tool in combination with PCC compared with traditional care. Trial Registration Swedish registry, Researchweb.org, ID NR 65 791.
DOI：
10.1056/nejmoa1010029
发表时间：
2010-12-09
期刊：
The New England journal of medicine
影响因子：
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作者：
Chaudhry SI;Mattera JA;Curtis JP;Spertus JA;Herrin J;Lin Z;Phillips CO;Hodshon BV;Cooper LS;Krumholz HM
通讯作者：
Krumholz HM