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一项关于移动健康干预促进肺移植后自我管理的随机对照试验。

A Randomized Controlled Trial of a Mobile Health Intervention to Promote Self-Management After Lung Transplantation.

作者信息

DeVito Dabbs A, Song M K, Myers B A, Li R, Hawkins R P, Pilewski J M, Bermudez C A, Aubrecht J, Begey A, Connolly M, Alrawashdeh M, Dew M A

机构信息

University of Pittsburgh, School of Nursing, Pittsburgh, PA.

School of Nursing, Emory, Atlanta, GA.

出版信息

Am J Transplant. 2016 Jul;16(7):2172-80. doi: 10.1111/ajt.13701. Epub 2016 Mar 14.

Abstract

Lung transplant recipients are encouraged to perform self-management behaviors, including (i) monitoring health indicators, (ii) adhering to their regimen, and (iii) reporting abnormal health indicators to the transplant coordinator, yet performance is suboptimal. When hospital discharge was imminent, this two-group trial randomized 201 recipients to use either the mobile health (mHealth) intervention (n = 99) or usual care (n = 102), to compare efficacy for promoting self-management behaviors (primary outcomes) and self-care agency, rehospitalization, and mortality (secondary outcomes) at home during the first year after transplantation. The mHealth intervention group performed self-monitoring (odds ratio [OR] 5.11, 95% confidence interval [CI] 2.95-8.87, p < 0.001), adhered to medical regimen (OR 1.64, 95% CI 1.01-2.66, p = 0.046), and reported abnormal health indicators (OR 8.9, 95% CI 3.60-21.99, p < 0.001) more frequently than the usual care group. However, the two groups did not differ in rehospitalization (OR 0.78, 95% CI 0.36-1.66, p = 0.51) or mortality (hazard ratio 1.71, 0.68-4.28, p = 0.25). The positive impact of the mHealth intervention on self-management behaviors suggests that the intervention holds promise and warrants further testing.

摘要

鼓励肺移植受者进行自我管理行为,包括:(i)监测健康指标;(ii)遵守治疗方案;(iii)向移植协调员报告异常健康指标,但实际执行情况并不理想。在即将出院时,这项两组试验将201名受者随机分为两组,一组使用移动健康(mHealth)干预措施(n = 99),另一组接受常规护理(n = 102),以比较在移植后第一年在家中促进自我管理行为(主要结局)、自我护理能力、再次住院和死亡率(次要结局)方面的效果。mHealth干预组进行自我监测的频率更高(优势比[OR] 5.11,95%置信区间[CI] 2.95 - 8.87,p < 0.001),遵守医疗方案的情况更好(OR 1.64,95% CI 1.01 - 2.66,p = 0.046),报告异常健康指标的频率也更高(OR 8.9,95% CI 3.60 - 21.99,p < 0.001)。然而,两组在再次住院率(OR 0.78,95% CI 0.36 - 1.66,p = 0.51)或死亡率(风险比1.71,0.68 - 4.28,p = 0.25)方面没有差异。mHealth干预对自我管理行为的积极影响表明该干预措施具有前景,值得进一步测试。

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