1Department of Patient and Care, Maastricht University Medical Centre, and CAPHRI, Department of Health Services Research, Maastricht University, The Netherlands.
Eur J Cardiovasc Nurs. 2014 Jun;13(3):243-52. doi: 10.1177/1474515113487464. Epub 2013 Apr 29.
The education of patients with heart failure (HF) is an essential part of disease management. The perspectives of an increasing number of patients and a shortage of professionals force healthcare to explore new strategies in supporting patients to be better informed and more active.
Three hundred and eighty-two patients with HF (age 71±SD 11.2 years) were randomly assigned to either a telemonitoring or a usual care group. Patients received four postal questionnaires to assess their levels of self-reported knowledge, self-care, self-efficacy and adherence. Generalized estimating equations analysis was performed to assess the effects of telemonitoring during the 1-year follow-up. Corrections for baseline were performed if needed.
Baseline differences between groups were found for self-care (p=0.001) and self-efficacy (p=0.024). Knowledge of patients in the telemonitoring group significantly improved with 0.9 point on a 15-points scale (p<0.001). Their self-care abilities improved with 1.5 point on a 10-item scale whereas no changes were found in patients receiving usual care (p<0.001). Self-efficacy of patients in the intervention group improved significantly after 6 months yet was not significantly different after 3 months and 1 year. For patients in the intervention group adherence improved for daily weighing (p<0.001) during the whole follow-up and for fluid intake (p=0.019) after 3 months and after 12 months (p=0.086). Adherence for activity recommendations improved (p=0.023) after 3 months and importance of medication adherence increased after 6 (p=0.012) and 12 months (p=0.037). No effects were found regarding appointments, diet, smoking and use of alcohol.
Tailored telemonitoring was found to educate patients with HF and to improve their self-care abilities and sense of self-efficacy.
心力衰竭（HF）患者的教育是疾病管理的重要组成部分。越来越多的患者和专业人员短缺的观点迫使医疗保健探索新的策略来支持患者更好地了解病情并更加积极主动。
将 382 名 HF 患者（年龄 71±SD 11.2 岁）随机分配到远程监测组或常规护理组。患者接受了四次邮寄问卷，以评估他们的自我报告知识、自我护理、自我效能和依从性水平。使用广义估计方程分析评估了 1 年随访期间远程监测的效果。如果需要，则对基线进行校正。
两组患者在自我护理（p=0.001）和自我效能（p=0.024）方面存在基线差异。远程监测组患者的知识显著提高了 0.9 分（p<0.001）。他们的自我护理能力提高了 1.5 分（10 项量表），而常规护理组患者则没有变化（p<0.001）。干预组患者的自我效能在 6 个月后显著提高，但在 3 个月和 1 年后没有显著差异。对于干预组患者，在整个随访期间，日常称重的依从性显著提高（p<0.001），而在 3 个月和 12 个月后，液体摄入的依从性也有所提高（p=0.019）。在 3 个月和 6 个月后，活动建议的依从性也有所提高（p=0.023），而在 6 个月和 12 个月后，药物依从性的重要性也有所提高（p=0.012 和 p=0.037）。在预约、饮食、吸烟和饮酒方面没有发现效果。
定制的远程监测被发现可以教育 HF 患者，并提高他们的自我护理能力和自我效能感。
