Powers Benjamin J, Olsen Maren K, Oddone Eugene Z, Bosworth Hayden B
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC 27705, USA.
Am J Med. 2009 Jul;122(7):639-46. doi: 10.1016/j.amjmed.2008.12.022.
Most patient chronic disease self-management interventions target single-disease outcomes. We evaluated the effect of a tailored hypertension self-management intervention on the unintended targets of glycosylated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-C).
We evaluated patients from the Veterans Study to Improve the Control of Hypertension, a 2-year randomized controlled trial. Patients received either a hypertension self-management intervention delivered by a nurse over the telephone or usual care. Although the study focused on hypertension self-management, we compared changes in HbA1c among a subgroup of 216 patients with diabetes and LDL-C among 528 patients with measurements during the study period. Changes in these laboratory values over time were compared between the 2 treatment groups using linear mixed-effects models.
For the patients with diabetes, the hypertension self-management intervention resulted in a 0.46% reduction in HbA1c over 2 years compared with usual care (95% confidence interval, 0.04%-0.89%; P = .03). For LDL-C, there was a minimal 0.9 mg/dL between-group difference that was not statistically significant (95% confidence interval, -7.3-5.6 mg/dL; P = .79).
There was a significant effect of the self-management intervention on the unintended target of HbA1c, but not LDL-C. Chronic disease self-management interventions might have "spill-over" effects on patients' comorbid chronic conditions.
大多数患者慢性病自我管理干预措施针对单一疾病结局。我们评估了一种量身定制的高血压自我管理干预措施对糖化血红蛋白（HbA1c）和低密度脂蛋白胆固醇（LDL-C）这些非预期目标的影响。
我们对退伍军人高血压控制改善研究中的患者进行了评估，这是一项为期2年的随机对照试验。患者要么接受护士通过电话提供的高血压自我管理干预，要么接受常规护理。尽管该研究侧重于高血压自我管理，但我们比较了216例糖尿病患者亚组中HbA1c的变化以及528例在研究期间有测量值的患者中LDL-C的变化。使用线性混合效应模型比较了两个治疗组之间这些实验室值随时间的变化。
对于糖尿病患者，与常规护理相比，高血压自我管理干预在2年内使HbA1c降低了0.46%（95%置信区间，0.04% - 0.89%；P = 0.03）。对于LDL-C，组间差异极小，为0.9mg/dL，无统计学意义（95%置信区间，-7.3 - 5.6mg/dL；P = 0.79）。
自我管理干预对HbA1c这一非预期目标有显著影响，但对LDL-C没有影响。慢性病自我管理干预措施可能对患者的合并慢性病有“溢出”效应。
