信息及电话引导获取社区支持对慢性肾病患者的影响：随机对照试验
Effect of information and telephone-guided access to community support for people with chronic kidney disease: randomised controlled trial.
作者信息
Blakeman Tom, Blickem Christian, Kennedy Anne, Reeves David, Bower Peter, Gaffney Hannah, Gardner Caroline, Lee Victoria, Jariwala Praksha, Dawson Shoba, Mossabir Rahena, Brooks Helen, Richardson Gerry, Spackman Eldon, Vassilev Ivaylo, Chew-Graham Carolyn, Rogers Anne
机构信息
NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
NIHR CLAHRC Wessex, Health Sciences, University of Southampton, Highfield Campus, Southampton, United Kingdom.
出版信息
PLoS One. 2014 Oct 16;9(10):e109135. doi: 10.1371/journal.pone.0109135. eCollection 2014.
BACKGROUND
Implementation of self-management support in traditional primary care settings has proved difficult, encouraging the development of alternative models which actively link to community resources. Chronic kidney disease (CKD) is a common condition usually diagnosed in the presence of other co-morbidities. This trial aimed to determine the effectiveness of an intervention to provide information and telephone-guided access to community support versus usual care for patients with stage 3 CKD.
METHODS AND FINDINGS
In a pragmatic, two-arm, patient level randomised controlled trial 436 patients with a diagnosis of stage 3 CKD were recruited from 24 general practices in Greater Manchester. Patients were randomised to intervention (215) or usual care (221). Primary outcome measures were health related quality of life (EQ-5D health questionnaire), blood pressure control, and positive and active engagement in life (heiQ) at 6 months. At 6 months, mean health related quality of life was significantly higher for the intervention group (adjusted mean difference = 0.05; 95% CI = 0.01, 0.08) and blood pressure was controlled for a significantly greater proportion of patients in the intervention group (adjusted odds-ratio = 1.85; 95% CI = 1.25, 2.72). Patients did not differ significantly in positive and active engagement in life. The intervention group reported a reduction in costs compared with control.
CONCLUSIONS
An intervention to provide tailored information and telephone-guided access to community resources was associated with modest but significant improvements in health related quality of life and better maintenance of blood pressure control for patients with stage 3 CKD compared with usual care. However, further research is required to identify the mechanisms of action of the intervention.
TRIAL REGISTRATION
Controlled-Trials.com ISRCTN45433299.
背景
在传统基层医疗环境中实施自我管理支持已被证明困难重重，这促使了与社区资源积极联动的替代模式的发展。慢性肾脏病（CKD）是一种常见疾病，通常在存在其他合并症的情况下被诊断出来。本试验旨在确定一项干预措施的有效性，该干预措施为3期CKD患者提供信息并通过电话引导其获得社区支持，与常规护理进行对比。
方法与结果
在一项务实的双臂、患者层面的随机对照试验中，从大曼彻斯特的24家全科诊所招募了436名诊断为3期CKD的患者。患者被随机分为干预组（215人）或常规护理组（221人）。主要结局指标为6个月时的健康相关生活质量（EQ - 5D健康问卷）、血压控制以及积极参与生活（heiQ）情况。在6个月时，干预组的平均健康相关生活质量显著更高（调整后平均差异 = 0.05；95%置信区间 = 0.01，0.08），且干预组中血压得到控制的患者比例显著更高（调整后比值比 = 1.85；95%置信区间 = 1.25，2.72）。患者在积极参与生活方面没有显著差异。与对照组相比，干预组报告成本有所降低。
结论
与常规护理相比，一项提供量身定制信息并通过电话引导获取社区资源的干预措施，使3期CKD患者的健康相关生活质量有适度但显著的改善，且血压控制维持得更好。然而，需要进一步研究以确定该干预措施的作用机制。
试验注册
Controlled - Trials.com ISRCTN45433299
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