Absolute cardiovascular disease risk and shared decision making in primary care:: A randomized controlled trial
Absolute cardiovascular disease risk and shared decision making in primary care:: A randomized controlled trial
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DOI：
10.1370/afm.854
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发表时间：
2008-05-01
影响因子：
4.4
通讯作者：
Donner-Banzhoff, Norbert
中科院分区：
文献类型：
--
作者：
Krones, Tanja;Keller, Heidemarie;Donner-Banzhoff, Norbert
我们希望通过传播一个简单的决策援助，用于家庭实践consultations.METHODS的研究是基于一个务实的，集群随机对照试验（第111期），继续医学教育（CME）组的家庭医生作为单位的随机化，以确定有效的沟通绝对心血管疾病（CVD）的风险和共同决策的效果。在干预组中，44名医生（7个CME组）连续招募了550名患者，测量了他们的胆固醇水平。对照组（7个CME组）中的47名医生同样纳入了582例患者。随访时观察到干预组460例患者（83.6%）和对照组466例患者（80.1%）。医生参加了2次互动式CME会议，并收到了一本小册子，一个基于纸张的风险计算器，和每个病人的个人总结表。对照组医生参加了1次关于替代主题的CME会议。主要结果测量指标为患者满意度和参与指数咨询后，心血管疾病风险状态的变化，并在6个月的following.ResultsIntervention患者的决策后悔明显更满意的过程和结果（患者参与量表，差异0.80，P <0.001）。在随访时，决定性后悔显著降低（差异3.39，P = .02）。CVD风险下降，在两组之间没有显着差异studyarms.CONCLUSION计算绝对个人CVD风险和促进共同决策CVD预防的基础上，一个简单的交易决策援助可以通过CME组传播，并可能导致更高的患者满意度和参与度和决策遗憾，而不会产生负面影响全球CVD风险。
PURPOSE We wanted to determine the effect of promoting the effective communication of absolute cardiovascular disease (CVD) risk and shared decision making through disseminating a simple decision aid for use in family practice consultations.METHODS The study was based on a pragmatic, cluster randomized controlled trial (phase 111) with continuing medical education (CME) groups of family physicians as the unit of randomization. In the intervention arm, 44 physicians (7 CME groups) consecutively recruited 550 patients in whom cholesterol levels were measured. Forty-seven physicians in the control arm (7 CME groups) similarly included 582 patients. Four hundred sixty patients (83.6%) of the intervention arm and 466 patients (80.1%) of the control arm were seen at follow-up. Physicians attended 2 interactive CME sessions and received a booklet, a paper-based risk calculator, and individual summary sheets for each patient. Control physicians attended 1 CME-session on an alternative topic. Main outcome measures were patient satisfaction and participation after the index consultation, change in CVD risk status, and decisional regret at 6 months' follow-up.RESULTS Intervention patients were significantly more satisfied with process and result (Patient Participation Scale, difference 0.80, P < .001). Decisional regret was significantly lower at follow-up (difference 3.39, P = .02). CVD risk decreased in both groups without a significant difference between study arms.CONCLUSION A simple transactional decision aid based on calculating absolute individual CVD risk and promoting shared decision making in CVD prevention can be disseminated through CME groups and may lead to higher patient satisfaction and involvement and less decisional regret, without negatively affecting global CVD risk.