Primary Care Clinical Sciences, School of Health and Population Sciences, Primary Care Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
Fam Pract. 2011 Apr;28(2):134-40. doi: 10.1093/fampra/cmq089. Epub 2010 Nov 10.
Research related to service requirements for anticoagulation management has focussed on clinical and health economic outcomes and paid little attention to the impact of treatment and service delivery on patients' quality of life. This was the first large UK study to evaluate the effect of patient self-management (PSM) of oral anticoagulation on treatment-related quality of life (TRQoL) and anxiety in comparison with routine care (RC) and to explore the effect of level of therapeutic control on TRQoL and anxiety across and within each model of care.
A quantitative survey, set in primary care in the West Midlands. The subjects were 517 randomized controlled trial participants, 242 receiving PSM and 275 RC. Postal questionnaires at baseline and 12 months comprised the State Trait Anxiety Inventory and a treatment-specific measure of positive (satisfaction and self-efficacy) and negative aspects (daily hassles, strained social network and psychological distress) of TRQoL. Change in anxiety and TRQoL scores were compared between PSM and RC. Subgroup analysis was based upon level of therapeutic control (high, medium and low).
Overall, 83% (n = 202) PSM and 55% (n = 161) RC patients contributed data. Anxiety scores were similar in both groups. PSM demonstrated greater improvement in self-efficacy than RC across the study period. A statistically significant between-group difference (PSM versus RC) in the self-efficacy also existed in subgroups with medium and high levels of therapeutic control.
PSM is not associated with increased anxiety and has a positive effect upon some aspects of TRQoL compared to RC.
与抗凝管理服务需求相关的研究主要集中在临床和健康经济结果上，而对治疗和服务提供对患者生活质量的影响关注甚少。这是第一项在英国进行的大型研究，旨在评估患者自我管理（PSM）口服抗凝剂治疗对治疗相关生活质量（TRQoL）和焦虑的影响，并与常规护理（RC）进行比较，并探讨治疗控制水平对 TRQoL 和焦虑的影响跨越和在每种护理模式内。
一项定量调查，在西米德兰兹郡的基层医疗中进行。受试者为 517 名随机对照试验参与者，其中 242 名接受 PSM，275 名接受 RC。基线和 12 个月的邮寄问卷包括状态特质焦虑量表和治疗特异性的积极（满意度和自我效能）和消极方面（日常麻烦、紧张的社交网络和心理困扰）的 TRQoL 测量。比较 PSM 和 RC 之间焦虑和 TRQoL 评分的变化。亚组分析基于治疗控制水平（高、中、低）。
总体而言，83%（n=202）的 PSM 和 55%（n=161）的 RC 患者提供了数据。两组焦虑评分相似。与 RC 相比，PSM 在整个研究期间自我效能的改善更大。在中等和高水平治疗控制的亚组中，PSM 与 RC 之间也存在自我效能的统计学显著组间差异。
与 RC 相比，PSM 不会增加焦虑，并且与某些方面的 TRQoL 有积极影响。
