Effects of a person-centred telephone-support in patients with chronic obstructive pulmonary disease and/or chronic heart failure - A randomized controlled trial.
Effects of a person-centred telephone-support in patients with chronic obstructive pulmonary disease and/or chronic heart failure - A randomized controlled trial.
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DOI：
10.1371/journal.pone.0203031
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Ekman I
中科院分区：
文献类型：
--
作者：
Fors A;Blanck E;Ali L;Ekberg-Jansson A;Fu M;Lindström Kjellberg I;Mäkitalo Å;Swedberg K;Taft C;Ekman I
评估以人为本的支持，通过电话在两个慢性病患者组，慢性阻塞性肺疾病（COPD）和/或慢性心力衰竭（CHF）的影响。将221例≥ 50岁的COPD和/或CHF患者随机分为常规治疗组与常规治疗加以人为中心的电话支持干预组，并随访6个月。干预组的患者最初由注册护士打电话与患者共同制定以人为本的健康计划，随后讨论和评估该计划。主要结局指标为综合评分，包括一般自我效能（GSE）、再住院和死亡。如果GSE降低≥ 5分，或如果患者因与COPD和/或CHF相关的计划外原因再次入院，或如果患者死亡，则将患者归类为恶化。在6个月的随访中，两个研究组的综合评分没有差异意向性治疗分析（n = 221）中（57.6%，n = 68 vs. 46.6%，n = 48; OR = 1.6，95% CI：0.9-2.7; P = 0.102）;然而，对照组中有更多的患者表现出具有临床意义的GSE降低，（≥ 5个单位）（22.9%，n = 27 vs. 9.7%，n = 10; OR = 2.8，95% CI：1.3-6.0; P = 0.011）。对照组有49例临床事件（14例死亡，35例再次入院），干预组有41例（9例死亡，32例再次入院）。综合评分的符合方案分析（n = 202）显示，对照组中恶化的患者多于干预组（57.6%，n = 68 vs. 42.9%，n = 36; OR = 1.8，95% CI 1.0-3.2; P = 0.039）。通过电话提供以人为本的支持可缓解慢性CHF和/或COPD患者自我效能的恶化，而不会增加临床事件的风险。这表明，即使在弱势患者群体中，也可以建立患者与医疗保健专业人员的伙伴关系，而无需面对面的咨询。ISRCTN.com ISRCTN55562827。
To evaluate the effects of person-centred support via telephone in two chronically ill patient groups, chronic obstructive pulmonary disease (COPD) and/or chronic heart failure (CHF). 221 patients ≥ 50 years with COPD and/or CHF were randomized to usual care vs. usual care plus a person-centred telephone-support intervention and followed for six months. Patients in the intervention group were telephoned by a registered nurse initially to co-create a person-centred health plan with the patient and subsequently to discuss and evaluate the plan. The primary outcome measure was a composite score comprising General Self-Efficacy (GSE), re-hospitalization and death. Patients were classified as deteriorated if GSE had decreased by ≥ 5 points, or if they had been re-admitted to hospital for unscheduled reasons related to COPD and/or CHF or if they had died. At six-month follow-up no difference in the composite score was found between the two study groups (57.6%, n = 68 vs. 46.6%, n = 48; OR = 1.6, 95% CI: 0.9–2.7; P = 0.102) in the intention-to-treat analysis (n = 221); however, significantly more patients in the control group showed a clinically important decrease in GSE (≥ 5 units) (22.9%, n = 27 vs. 9.7%, n = 10; OR = 2.8, 95% CI: 1.3–6.0; P = 0.011). There were 49 clinical events (14 deaths, 35 re-admissions) in the control group and 41 in the intervention group (9 deaths, 32 re-admissions). Per-protocol analysis (n = 202) of the composite score showed that more patients deteriorated in the control group than in the intervention group (57.6%, n = 68 vs. 42.9%, n = 36; OR = 1.8, 95% CI 1.0–3.2; P = 0.039). Person-centred support via telephone mitigates worsening self-efficacy without increasing the risk of clinical events in chronically ill patients with CHF and/or COPD. This indicates that a patient-healthcare professional partnership may be established without the need for face-to-face consultations, even in vulnerable patient groups. ISRCTN.com ISRCTN55562827.
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