Nurse Care Coordination and Technology Effects on Health Status of Frail Older Adults via Enhanced Self-Management of Medication: Randomized Clinical Trial to Test Efficacy
Nurse Care Coordination and Technology Effects on Health Status of Frail Older Adults via Enhanced Self-Management of Medication: Randomized Clinical Trial to Test Efficacy
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DOI：
10.1097/nnr.0b013e318298aa55
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发表时间：
2013-07-01
期刊：
影响因子：
2.5
通讯作者：
O'Brien, Anne-Marie
中科院分区：
文献类型：
--
作者：
Marek, Karen Dorman;Stetzer, Frank;O'Brien, Anne-Marie
背景：慢性病复杂药物治疗方案的自我管理对许多老年人来说是一项挑战。目的：本研究的目的是评估接受家庭支持计划的虚弱老年人的健康状况结果，该计划强调使用护理协调和技术进行药物自我管理。设计：本研究采用了一项随机对照试验，包括三个臂和纵向结果测量。设置：在中西部城市地区的三个Medicare认证的家庭医疗保健机构出院时招募了难以自我管理药物的老年人（n = 414）。方法：所有参与者接受基线药房筛选。对照组不接受进一步的干预。一个由高级实践护士和注册护士组成的团队对两个干预组进行了为期12个月的协调护理，这些干预组还接受了MD.2药物分配机或medplanner。健康状况的结果（老年抑郁量表，迷你精神状态检查，体能测试，SF-36身体成分总结和精神成分总结）进行了测量，在基线和3，6，9，和12 months.Results：协变量和基线健康状况调整后，时间x组的相互作用的MD。2和medplanner组的健康状况的结果并不显着。时间x组的相互作用是显着的medplanner和control groupcomparation.Discussion：与会者与护理协调有显着更好的健康状况的结果，随着时间的推移比那些在对照组，但除了MD.2机护士护理协调并没有导致更好的健康状况的结果。
Background:Self-management of complex medication regimens for chronic illness is challenging for many older adults.Objectives:The purpose of this study was to evaluate health status outcomes of frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology.Design:This study used a randomized controlled trial with three arms and longitudinal outcome measurement.Setting:Older adults having difficulty in self-managing medications (n = 414) were recruited at discharge from three Medicare-certified home healthcare agencies in a Midwestern urban area.Methods:All participants received baseline pharmacy screens. The control group received no further intervention. A team of advanced practice nurses and registered nurses coordinated care for 12 months to two intervention groups who also received either an MD.2 medication-dispensing machine or a medplanner. Health status outcomes (the Geriatric Depression Scale, Mini Mental Status Examination, Physical Performance Test, and SF-36 Physical Component Summary and Mental Component Summary) were measured at baseline and at 3, 6, 9, and 12 months.Results:After covariate and baseline health status adjustment, time x group interactions for the MD.2 and medplanner groups on health status outcomes were not significant. Time x group interactions were significant for the medplanner and control group comparisons.Discussion:Participants with care coordination had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better health status outcomes.