冠心病（CHD）管理创新患者资源的开发与测试：一项描述性研究。
Development and testing of innovative patient resources for the management of coronary heart disease (CHD): a descriptive study.
作者信息
Redfern Julie, Ellis Elizabeth, Briffa Tom, Freedman Saul B
机构信息
School of Physiotherapy, University of Sydney, Sydney, Australia.
出版信息
BMC Health Serv Res. 2006 Aug 6;6:95. doi: 10.1186/1472-6963-6-95.
BACKGROUND
Although heart disease is a major cause of morbidity and mortality the majority of patients do not access existing rehabilitation programs and patient resources are not designed to facilitate patient choice and decision-making. The objective of this study was to develop and test a series of risk factor modules and corresponding patient information leaflets for secondary prevention of CHD.
METHODS
In phase one, a series of risk factor modules and management options were developed following analysis of literature and interviews with health professionals. In phase two, module information leaflets were developed using published guidelines and interviews of people with CHD. In phase three, the leaflets were tested for quality (DISCERN), readability (Flesch) and suitability (SAM) and were compared to the existing cardiac rehabilitation (CR) information leaflet. Finally, the patients assessed the leaflets for content and relevance.
RESULTS
Four key risk factors identified were cholesterol, blood pressure, smoking and physical inactivity. Choice management options were selected for each risk factor and included medical consultation, intensive health professional led program, home program and self direction. Patient information needs were then identified and leaflets were developed. DISCERN quality scores were high for cholesterol (62/80), blood pressure (59/80), smoking (62/80) and physical activity (62/80), all scoring 4/5 for overall rating. The mean Flesch readability score was 75, representing "fairly easy to read", all leaflets scored in the superior category for suitability and were reported to be easy to understand, useful and motivating by persons with CHD risk factors. The developed leaflets scored higher on each assessment than the existing CR leaflets.
CONCLUSION
Using a progressive three phase approach, a series of risk factor modules and information leaflets were successfully developed and tested. The leaflets will contribute to shared-decision making and empowerment for persons with CHD.
背景
尽管心脏病是发病和死亡的主要原因，但大多数患者无法参与现有的康复项目，而且患者资源并非旨在促进患者选择和决策。本研究的目的是开发并测试一系列用于冠心病二级预防的风险因素模块以及相应的患者信息手册。
方法
在第一阶段，在对文献进行分析并与健康专业人员进行访谈之后，开发了一系列风险因素模块及管理选项。在第二阶段，利用已发布的指南并对冠心病患者进行访谈，编写了模块信息手册。在第三阶段，对手册进行了质量（DISCERN）、可读性（弗莱什）和适用性（SAM）测试，并与现有的心脏康复（CR）信息手册进行比较。最后，患者对手册的内容和相关性进行了评估。
结果
确定的四个关键风险因素为胆固醇、血压、吸烟和缺乏身体活动。为每个风险因素选择了相应的管理选项，包括医疗咨询、由健康专业人员主导的强化项目、家庭项目和自我指导。然后确定了患者的信息需求并编写了手册。胆固醇（62/80）、血压（59/80）、吸烟（62/80）和身体活动（62/80）的DISCERN质量评分较高，总体评分均为4/5。平均弗莱什可读性评分为75，表明“相当容易阅读”，所有手册在适用性方面均被评为高级类别，有冠心病风险因素的患者报告称这些手册易于理解、有用且具有激励作用。所编写的手册在各项评估中的得分均高于现有的心脏康复手册。
结论
采用渐进式的三阶段方法，成功开发并测试了一系列风险因素模块和信息手册。这些手册将有助于冠心病患者进行共同决策并增强其自主能力。
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