基于计算机的家庭中实体器官移植受者教育计划的随机对照试验：对药物知识、满意度和依从性的影响。
Randomized Controlled Trial of a Computer-Based Education Program in the Home for Solid Organ Transplant Recipients: Impact on Medication Knowledge, Satisfaction, and Adherence.
机构信息
1 Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada. 2 Department of Pharmacy Services, Toronto General Hospital, University Health Network, Toronto, ON, Canada. 3 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. 4 Division of Nephrology, Toronto General Hospital and St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. 5 Institute of Health Policy, Management, and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
出版信息
Transplantation. 2017 Jun;101(6):1336-1343. doi: 10.1097/TP.0000000000001279.
BACKGROUND
De novo solid organ transplant recipients (SOTR) have a steep learning curve to acquire medication knowledge. Without adequate knowledge, SOTR are at risk of nonadherence and poor transplant outcomes.
METHODS
In this nonblinded, randomized controlled trial, de novo SOTR received standard teaching with or without postdischarge computer-based education (CBE) at home. Primary outcomes were change in knowledge (quiz and recall) and satisfaction, assessed by questionnaires at baseline and 3 months. Adherence was evaluated via self-report and immunosuppressant levels.
RESULTS
Two hundred forty-six patients were randomized and 209 completed the 3-month analysis. In the intervention arm, 73 (57.9%) used the CBE program. Change in knowledge quiz score did not differ between groups (4.9% vs 0.6%; P = 0.084), despite a significant increase within the intervention (72.4% vs 77.3%, P = 0.007) but not the control (76.0% vs 76.6%, P = 0.726) arms. Both groups had a significant improvement in recall (intervention, 56.7% vs 82.1%, P < 0.001; control, 51.3% vs 79.7%, P < 0.001), with similar changes in scores (25.4% vs 28.4%, P = 0.55). Change in satisfaction differed between groups (intervention, 1.2% vs control, -4.9%; P = 0.050). There was a significant decline in satisfaction within the control group (88.4% vs 83.5%, P = 0.035), whereas satisfaction was maintained with the intervention (85.6% vs 86.8%, P = 0.55). Adherence was similar in both groups.
CONCLUSIONS
Knowledge improved over the study period in both groups, with no incremental benefit for the intervention. Patient satisfaction was maintained with the CBE program. More research is needed to identify barriers to uptake of CBE at home and to develop effective strategies for posttransplant education.
背景
从头开始接受实体器官移植的受者（SOTR）需要经历一段陡峭的学习曲线，以掌握药物知识。如果没有足够的知识，SOTR 就有可能不遵守医嘱，导致移植效果不佳。
方法
在这项非盲、随机对照试验中，从头开始的 SOTR 接受了标准教学，或在出院后在家中接受基于计算机的教育（CBE）。主要结果是通过问卷在基线和 3 个月时评估知识（测验和回忆）和满意度的变化。通过自我报告和免疫抑制剂水平评估依从性。
结果
共有 246 名患者被随机分配，209 名患者完成了 3 个月的分析。在干预组中，有 73 名（57.9%）使用了 CBE 程序。虽然干预组的知识测验分数有显著增加（72.4%比 77.3%，P=0.007），但两组之间的知识测验分数变化没有差异（4.9%比 0.6%，P=0.084），而对照组的知识测验分数也有显著增加（76.0%比 76.6%，P=0.726）。两组的回忆能力都有显著提高（干预组，56.7%比 82.1%，P<0.001；对照组，51.3%比 79.7%，P<0.001），且分数变化相似（25.4%比 28.4%，P=0.55）。两组的满意度变化不同（干预组，1.2%比对照组，-4.9%；P=0.050）。对照组的满意度显著下降（88.4%比 83.5%，P=0.035），而干预组的满意度保持不变（85.6%比 86.8%，P=0.55）。两组的依从性相似。
结论
两组患者的知识都在研究期间有所提高，但干预组没有额外的获益。CBE 项目维持了患者的满意度。需要进一步研究以确定在家中接受 CBE 的障碍，并制定有效的移植后教育策略。
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