CREATE Wellness: A multi-component behavioral intervention for patients not responding to traditional Cardiovascular disease management.
CREATE Wellness: A multi-component behavioral intervention for patients not responding to traditional Cardiovascular disease management.
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DOI：
10.1016/j.conctc.2017.10.001
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发表时间：
2017-12
影响因子：
1.5
通讯作者：
Grant RW
中科院分区：
文献类型：
--
作者：
Miller-Rosales C;Sterling SA;Wood SB;Ross T;Makki M;Zamudio C;Kane IM;Richardson MC;Samayoa C;Charvat-Aguilar N;Lu WY;Vo M;Whelan K;Uratsu CS;Grant RW
心血管疾病（CVD）是美国的首要死因。许多患者并没有从降低 CVD 风险的传统疾病管理方法中受益。在这里，我们描述了针对持续未达到 CVD 危险因素控制目标的患者的多成分行为干预的基本原理、开发和实施。根据已发表的证据、相关理论框架、利益相关者的建议和患者的意见，我们开发了一种基于小组的干预措施（改变结果：参与和激活以增强健康；“创造健康”），以满足心血管疾病相关风险因素升高或未测量的患者的复杂需求。我们正在一项随机试验中测试这种干预措施，对象是尽管参加了先进且非常成功的 CVD 疾病管理计划，但风险因素控制持续（即超过 2 年）次优的患者。 CREATE Wellness 干预措施被设计为 3 个疗程、以小组为基础的干预措施，结合了患者激活、卫生系统参与技能培训、共同决策、护理计划和识别生活方式改变障碍等经过验证的要素。我们在设计干预措施时学到的主要经验包括多层次利益相关者投入的价值以及解决护理障碍的实用技能培训的重要性。 CREATE Wellness 干预代表了一种以证据为基础、以患者为中心的方法，适用于对传统疾病管理没有反应的患者。该试验目前正在北加州凯撒医疗机构的三个医疗机构进行，后续步骤包括疗效评估、针对非英语患者群体的调整以及修改网络或电话版本的课程。 NCT02302612。
Cardiovascular disease (CVD) is the leading cause of death in the US. Many patients do not benefit from traditional disease management approaches to CVD risk reduction. Here we describe the rationale, development, and implementation of a multi-component behavioral intervention targeting patients who have persistently not met goals of CVD risk factor control. Informed by published evidence, relevant theoretical frameworks, stakeholder advice, and patient input, we developed a group-based intervention (Changing Results: Engage and Activate to Enhance Wellness; “CREATE Wellness”) to address the complex needs of patients with elevated or unmeasured CVD-related risk factors. We are testing this intervention in a randomized trial among patients with persistent (i.e > 2 years) sub-optimal risk factor control despite being enrolled in an advanced and highly successful CVD disease management program. The CREATE Wellness intervention is designed as a 3 session, group-based intervention combining proven elements of patient activation, health system engagement skills training, shared decision making, care planning, and identification of lifestyle change barriers. Our key learnings in designing the intervention included the value of multi-level stakeholder input and the importance of pragmatic skills training to address barriers to care. The CREATE Wellness intervention represents an evidence-based, patient-centered approach for patients not responding to traditional disease management. The trial is currently underway at three medical facilities within Kaiser Permanente Northern California and next steps include an evaluation of efficacy, adaptation for non-English speaking patient populations, and modification of the curriculum for web- or phone-based versions. NCT02302612.