一项针对慢性阻塞性肺疾病患者的文化敏感性自我管理干预的随机对照试验。
A randomized controlled trial of a literacy-sensitive self-management intervention for chronic obstructive pulmonary disease patients.
机构信息
School of Pharmacy, University of Maryland, Baltimore, MD, USA.
出版信息
J Gen Intern Med. 2012 Feb;27(2):190-5. doi: 10.1007/s11606-011-1867-6. Epub 2011 Sep 21.
BACKGROUND
Low literacy skills are common and associated with a variety of poor health outcomes. This may be particularly important in patients with chronic illnesses such as chronic obstructive pulmonary disease (COPD) that require appropriate inhaler technique to maintain quality of life and avoid exacerbations.
OBJECTIVE
To explore the impact of a literacy-sensitive self-management intervention on inhaler technique scores in COPD patients and to determine if effects differ by literacy.
DESIGN
Randomized controlled trial.
PARTICIPANTS
Ninety-nine patients with COPD.
INTERVENTION
Patients were randomly assigned to a one-on-one self-management educational intervention or usual care. The intervention focused on inhaler technique, smoking cessation, and using a COPD action plan.
MAIN MEASURES
At baseline, an inhaler technique assessment, literacy assessment, health-related quality of life questionnaires, and pulmonary function tests were completed. Inhaler technique was re-evaluated after two to eight weeks.
KEY RESULTS
Mean age 63, 65% female, 69% Caucasian, moderate COPD severity on average, 36% with low literacy, moderately impaired health-related quality of life, and similar baseline metered dose inhaler technique scores. Patients in the intervention group had greater mean improvement from baseline in metered dose inhaler technique score compared to those in the usual care group (difference in mean change 2.1, 95% CI 1.1, 3.0). The patients in the intervention group also had greater mean improvements in metered dose inhaler technique score than those in the usual care group whether they had low health literacy (difference in mean change 2.8, 95% CI 0.6, 4.9) or higher health literacy (1.8, 95% CI 0.7, 2.9).
CONCLUSIONS
A literacy-sensitive self-management intervention can lead to improvements in inhaler technique, with benefits for patients with both low and higher health literacy.
背景
低识字率很常见，并且与各种不良健康结果相关。在需要适当的吸入器技术来维持生活质量并避免恶化的慢性疾病患者中，情况可能尤其重要，例如慢性阻塞性肺疾病（COPD）。
目的
探讨识字敏感的自我管理干预对 COPD 患者吸入器技术评分的影响，并确定其效果是否因识字率而异。
设计
随机对照试验。
参与者
99 名 COPD 患者。
干预措施
患者被随机分配到一对一的自我管理教育干预或常规护理。干预侧重于吸入器技术、戒烟和使用 COPD 行动计划。
主要测量
在基线时，进行了吸入器技术评估、识字评估、健康相关生活质量问卷和肺功能测试。在两到八周后重新评估吸入器技术。
主要结果
平均年龄为 63 岁，65%为女性，69%为白种人，平均 COPD 严重程度中等，36%识字率较低，健康相关生活质量中度受损，并且基线使用计量吸入器的技术评分相似。与常规护理组相比，干预组患者的计量吸入器技术评分从基线的平均改善更大（平均变化差异 2.1，95%置信区间 1.1，3.0）。与常规护理组相比，干预组的患者在计量吸入器技术评分方面的平均改善也更大，无论他们的健康识字率较低（平均变化差异 2.8，95%置信区间 0.6，4.9）还是较高（1.8，95%置信区间 0.7，2.9）。
结论
识字敏感的自我管理干预可以改善吸入器技术，对低识字率和高识字率的患者均有益。
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