患者激活干预对戒烟和戒酒的影响：来自 PAADRN 随机对照试验的结果。
The effects of a patient activation intervention on smoking and excessive drinking cessations: results from the PAADRN randomized controlled trial.
机构信息
Department of Health Management and Policy, University of Iowa, 145 North Riverside Drive, CPHB N211, Iowa City, Iowa City, IA, 52242, USA.
Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
出版信息
Osteoporos Int. 2017 Oct;28(10):3055-3060. doi: 10.1007/s00198-017-4101-5. Epub 2017 Jun 1.
UNLABELLED
Patients may exhibit risky bone health behaviors. In a large pragmatic clinical trial, we tested whether a tailored patient activation DXA result letter accompanied by a bone health brochure led to smoking and excessive drinking cessations. The intervention did not, however, alter these risky bone health behaviors.
INTRODUCTION
Besides dual-energy x-ray absorptiometry (DXA) screening and pharmacotherapy when indicated, beneficial bone health behaviors including proper calcium and vitamin D intake and weight-bearing and muscle-strengthening exercise should be encouraged. Similarly, risky bone health behaviors like smoking and excessive drinking should be discouraged. We examined whether a direct-to-patient activation intervention led to smoking and excessive drinking cessations.
METHODS
The Patient Activation after DXA Result Notification (PAADRN) pragmatic clinical trial enrolled 7749 patients between February 2012 and August 2014. Interviews occurred at baseline and 12 and 52 weeks later. Intervention subjects were mailed an individually tailored DXA results letter accompanied by a bone health educational brochure 4 weeks post-DXA. Usual care subjects were not sent these materials. Smoking and excessive drinking were assessed by self-report at each interview. Intention-to-treat linear probability models were used.
RESULTS
Mean age was 66.6 years, 83.8% were women, and 75.3% were Non-Hispanic-Whites. Smoking was reported at baseline by 7.6% of the intervention group vs. 7.7% of the usual care group (p = 0.873). Excessive drinking was reported at baseline by 6.5% of the intervention group vs. 6.5% of the usual care group (p = 0.968). Intention-to-treat analyses indicated no significant differences between the intervention vs. usual care groups at either 12 or 52 weeks post-DXA (all p values ≥ 0.346).
CONCLUSION
An individually tailored DXA result letter accompanied by an educational brochure did not lead to smoking or excessive drinking cessations in patients who received DXA.
TRIAL REGISTRATION
clinicaltrials.gov identifier NCT01507662.
未加标签
患者可能表现出危险的骨骼健康行为。在一项大型实用临床试验中，我们测试了个性化的患者激活 DXA 结果信，同时附有骨骼健康小册子，这是否会导致戒烟和戒酒。然而，该干预措施并未改变这些危险的骨骼健康行为。
引言
除了双能 X 射线吸收法（DXA）筛查和有指征时的药物治疗外，还应鼓励患者养成有益的骨骼健康行为，包括适当摄入钙和维生素 D，以及进行负重和肌肉强化运动。同样，应劝阻危险的骨骼健康行为，如吸烟和酗酒。我们研究了直接向患者传达激活干预措施是否会导致戒烟和戒酒。
方法
患者 DXA 结果通知后的激活（PAADRN）实用临床试验于 2012 年 2 月至 2014 年 8 月期间招募了 7749 名患者。基线和 12 周和 52 周后进行访谈。干预组患者在 DXA 后 4 周内收到个性化的 DXA 结果信，附有骨骼健康教育小册子。常规护理组患者未收到这些材料。通过自我报告在每次访谈中评估吸烟和酗酒情况。采用意向治疗线性概率模型进行分析。
结果
平均年龄为 66.6 岁，83.8%为女性，75.3%为非西班牙裔白人。干预组在基线时报告吸烟的比例为 7.6%，而常规护理组为 7.7%（p=0.873）。干预组在基线时报告酗酒的比例为 6.5%，而常规护理组为 6.5%（p=0.968）。意向治疗分析表明，在 DXA 后 12 周或 52 周时，干预组与常规护理组之间没有显著差异（所有 p 值均≥0.346）。
结论
附有教育小册子的个性化 DXA 结果信并未导致接受 DXA 的患者戒烟或戒酒。
试验注册
clinicaltrials.gov 标识符 NCT01507662。
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