Multisite Randomized Trial of a Single-Session Versus Multisession Literacy-Sensitive Self-Care Intervention for Patients With Heart Failure
Multisite Randomized Trial of a Single-Session Versus Multisession Literacy-Sensitive Self-Care Intervention for Patients With Heart Failure
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DOI：
10.1161/circulationaha.111.081745
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发表时间：
2012-06-12
期刊：
影响因子：
37.8
通讯作者：
Pignone, Michael
中科院分区：
文献类型：
--
作者：
DeWalt, Darren A.;Schillinger, Dean;Pignone, Michael
背景-自我护理训练可以减少心力衰竭(HF)的住院时间，更密集的干预可能会使更多的脆弱患者受益，包括低文化程度的患者。方法和结果-对605名心力衰竭患者进行了为期1年的多点随机对照对照有效性试验。那些被随机分到一次会议的人接受了40分钟的面对面、对识字敏感的培训；多次会议组接受了同样的初始培训，然后是持续的电话支持。主要结果是全因住院或死亡的综合发生率；次要结果包括与心力衰竭相关的住院和与心力衰竭相关的生活质量，并根据识字情况进行预先指定的分层。总体而言，干预组之间全因住院和死亡的发生率没有差异(发生率比为1.01；95%可信区间为0.83-1.22)。多节训练和单节训练的效果因识字率不同而不同：在识字率低的人群中，多节训练的全因住院率和死亡率较低(发病率比为0.75；95%可信区间为0.45~1.25)，而在识字率较高的人群中，多时段干预的发病率较高(发病率比为1.22；95%可信区间为0.99~1.5；交互作用P=0.048)。对于心力衰竭相关的住院，在低文化程度的患者中，多节训练的发病率较低(发病率比为0.53；95%可信区间为0.25-1.12)，而在高文化程度的患者中，其发病率较高(发病率比为1.32；95%可信区间为0.92-1.88；交互作用P=0.005)。在1个月和6个月时，接受多疗程干预的患者与接受单次干预的患者相比，与接受单次干预的患者相比，心力衰竭相关生活质量的改善更多，但12个月时差异较小。对心力衰竭相关生活质量的影响在文学上没有不同。结论--总体来说，与单次干预相比，强化的多次干预不会改变临床结果。识字率低的人似乎比识字率高的人从多次干预中受益更多。
Background-Self-care training can reduce hospitalization for heart failure (HF), and more intensive intervention may benefit more vulnerable patients, including those with low literacy.Methods and Results-A 1-year, multisite, randomized, controlled comparative effectiveness trial with 605 patients with HF was conducted. Those randomized to a single session received a 40-minute in-person, literacy-sensitive training; the multisession group received the same initial training and then ongoing telephone-based support. The primary outcome was combined incidence of all-cause hospitalization or death; secondary outcomes included HF-related hospitalization and HF-related quality of life, with prespecified stratification by literacy. Overall, the incidence of all-cause hospitalization and death did not differ between intervention groups (incidence rate ratio, 1.01; 95% confidence interval, 0.83-1.22). The effect of multisession training compared with single-session training differed by literacy group: Among those with low literacy, the multisession training yielded a lower incidence of all-cause hospitalization and death (incidence rate ratio, 0.75; 95% confidence interval, 0.45-1.25), and among those with higher literacy, the multisession intervention yielded a higher incidence (incidence rate ratio, 1.22; 95% confidence interval, 0.99-1.50; interaction P=0.048). For HF-related hospitalization, among those with low literacy, multisession training yielded a lower incidence (incidence rate ratio, 0.53; 95% confidence interval, 0.25-1.12), and among those with higher literacy, it yielded a higher incidence (incidence rate ratio, 1.32; 95% confidence interval, 0.92-1.88; interaction P=0.005). HF-related quality of life improved more for patients receiving multisession than for those receiving single-session interventions at 1 and 6 months, but the difference at 12 months was smaller. Effects on HF-related quality of life did not differ by literacy.Conclusions-Overall, an intensive multisession intervention did not change clinical outcomes compared with a single-session intervention. People with low literacy appear to benefit more from multisession interventions than people with higher literacy.