Department of Social and Welfare studies (HAV), Linköping University, Linköping, Sweden.
BMC Fam Pract. 2012 Nov 20;13:110. doi: 10.1186/1471-2296-13-110.
Even though there is convincing evidence that self-care, such as regular exercise and/or stopping smoking, alters the outcomes after an event of coronary heart disease (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention programmes are structurally and pedagogically applied using adult learning principles e.g. problem-based learning (PBL). Until now, most education programs for patients with CHD have not been based on such principles. The basic aim is to discover whether PBL provided in primary health care (PHC) has long-term effects on empowerment and self-care after an event of CHD.
METHODS/DESIGN: A randomised controlled study is planned for patients with CHD. The primary outcome is empowerment to reach self-care goals. Data collection will be performed at baseline at hospital and after one, three and five years in PHC using quantitative and qualitative methodologies involving questionnaires, medical assessments, interviews, diaries and observations. Randomisation of 165 patients will take place when they are stable in their cardiac condition and have optimised cardiac medication that has not substantially changed during the last month. All patients will receive conventional care from their general practitioner and other care providers. The intervention consists of a patient education program in PHC by trained district nurses (tutors) who will apply PBL to groups of 6-9 patients meeting on 13 occasions for two hours over one year. Patients in the control group will not attend a PBL group but will receive home-sent patient information on 11 occasions during the year.
We expect that the 1-year PBL-patient education will improve patients' beliefs, self-efficacy and empowerment to achieve self-care goals significantly more than one year of standardised home-sent patient information. The assumption is that PBL will reduce cardiovascular events in the long-term and will also be cost-effective compared to controls. Further, the knowledge obtained from this study may contribute to improving patients' ability to handle self-care, and furthermore, may reduce the number of patients having subsequent CHD events in Sweden.
NCT01462799.
尽管有确凿的证据表明自我保健，如定期锻炼和/或戒烟，可以改变冠心病（CHD）事件后的结果，但风险因素仍然存在。如果使用成人学习原则（如基于问题的学习（PBL））结构性和教学性地应用二级预防计划的核心组成部分，那么结果可以得到改善。到目前为止，大多数冠心病患者的教育计划都没有基于这些原则。基本目的是发现初级保健（PHC）中提供的 PBL 是否对 CHD 事件后实现赋权和自我保健有长期影响。
方法/设计：计划为 CHD 患者进行一项随机对照研究。主要结局是实现自我保健目标的赋权。将在医院进行基线数据收集，然后在 PHC 中在 1、3 和 5 年进行数据收集，使用涉及问卷、医学评估、访谈、日记和观察的定量和定性方法。当患者心脏状况稳定且已优化心脏药物且在过去一个月内没有实质性变化时，将对 165 名患者进行随机分组。所有患者将从他们的全科医生和其他护理提供者那里获得常规护理。干预措施包括由经过培训的地区护士（导师）在 PHC 中为患者提供教育计划，他们将在一年内在 13 次会议上为 6-9 名患者组成的小组应用 PBL，每次会议持续两个小时。对照组患者将不参加 PBL 小组，但在一年内将收到 11 次家庭发送的患者信息。
我们预计，与一年标准化家庭发送患者信息相比，为期一年的 PBL-患者教育将显著改善患者实现自我保健目标的信念、自我效能和赋权。假设 PBL 将在长期内减少心血管事件，并且与对照组相比具有成本效益。此外，从这项研究中获得的知识可能有助于提高患者自我保健的能力，并且还可以减少瑞典随后发生 CHD 事件的患者数量。
NCT01462799。
