一项旨在减少社区获得性肺炎医疗资源的教育项目的影响：EDUCAP随机对照试验
Impact of an Educational Program to Reduce Healthcare Resources in Community-Acquired Pneumonia: The EDUCAP Randomized Controlled Trial.
作者信息
Adamuz Jordi, Viasus Diego, Simonetti Antonella, Jiménez-Martínez Emilio, Molero Lorena, González-Samartino Maribel, Castillo Elena, Juvé-Udina María-Eulalia, Alcocer María-Jesús, Hernández Carme, Buera María-Pilar, Roel Asunción, Abad Emilia, Zabalegui Adelaida, Ricart Pilar, Gonzalez Anna, Isla Pilar, Dorca Jordi, Garcia-Vidal Carolina, Carratalà Jordi
机构信息
Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain; Department of Nursing, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain; School of Health Science, Blanquerna-Ramon Llull University, Barcelona, Spain.
Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain; Clinical Research and Biotechnology Groups, Faculty of Medicine, Universidad del Norte, Barranquilla, Colombia.
出版信息
PLoS One. 2015 Oct 13;10(10):e0140202. doi: 10.1371/journal.pone.0140202. eCollection 2015.
BACKGROUND
Additional healthcare visits and rehospitalizations after discharge are frequent among patients with community-acquired pneumonia (CAP) and have a major impact on healthcare costs. We aimed to determine whether the implementation of an individualized educational program for hospitalized patients with CAP would decrease subsequent healthcare visits and readmissions within 30 days of hospital discharge.
METHODS
A multicenter, randomized trial was conducted from January 1, 2011 to October 31, 2014 at three hospitals in Spain. We randomly allocated immunocompetent adults patients hospitalized for CAP to receive either an individualized educational program or conventional information before discharge. The educational program included recommendations regarding fluid intake, adherence to drug therapy and preventive vaccines, knowledge and management of the disease, progressive adaptive physical activity, and counseling for alcohol and smoking cessation. The primary trial endpoint was a composite of the frequency of additional healthcare visits and rehospitalizations within 30 days of hospital discharge. Intention-to-treat analysis was performed.
RESULTS
We assigned 102 patients to receive the individualized educational program and 105 to receive conventional information. The frequency of the composite primary end point was 23.5% following the individualized program and 42.9% following the conventional information (difference, -19.4%; 95% confidence interval, -6.5% to -31.2%; P = 0.003).
CONCLUSIONS
The implementation of an individualized educational program for hospitalized patients with CAP was effective in reducing subsequent healthcare visits and rehospitalizations within 30 days of discharge. Such a strategy may help optimize available healthcare resources and identify post-acute care needs in patients with CAP.
TRIAL REGISTRATION
Controlled-Trials.com ISRCTN39531840.
背景
社区获得性肺炎（CAP）患者出院后频繁进行额外的医疗就诊和再次住院，这对医疗费用有重大影响。我们旨在确定为住院的CAP患者实施个性化教育计划是否会减少出院后30天内的后续医疗就诊和再入院情况。
方法
2011年1月1日至2014年10月31日在西班牙的三家医院进行了一项多中心随机试验。我们将因CAP住院的免疫功能正常的成年患者随机分配，使其在出院前接受个性化教育计划或常规信息。教育计划包括关于液体摄入、坚持药物治疗和预防性疫苗接种、疾病知识和管理、渐进性适应性体育活动以及戒酒和戒烟咨询等建议。主要试验终点是出院后30天内额外医疗就诊和再住院频率的综合指标。进行了意向性分析。
结果
我们分配102例患者接受个性化教育计划，105例接受常规信息。个性化计划后综合主要终点的频率为23.5%，常规信息后为42.9%（差异为-19.4%；95%置信区间为-6.5%至-31.2%；P = 0.003）。
结论
为住院的CAP患者实施个性化教育计划可有效减少出院后30天内的后续医疗就诊和再住院情况。这样的策略可能有助于优化可用医疗资源，并确定CAP患者的急性后护理需求。
试验注册
Controlled-Trials.com ISRCTN39531840
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