Schäfer Ingmar, Kaduszkiewicz Hanna, Mellert Christine, Löffler Christin, Mortsiefer Achim, Ernst Annette, Stolzenbach Carl-Otto, Wiese Birgitt, Abholz Heinz-Harald, Scherer Martin, van den Bussche Hendrik, Altiner Attila
Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Medical Faculty, Institute of General Practice, University of Kiel, Kiel, Germany.
BMJ Open. 2018 Jan 23;8(1):e017653. doi: 10.1136/bmjopen-2017-017653.
To determine if patient-centred communication leads to a reduction of the number of medications taken without reducing health-related quality of life.
Two-arm cluster-randomised controlled trial.
55 primary care practices in Hamburg, Düsseldorf and Rostock, Germany.
604 patients 65 to 84 years of age with at least three chronic conditions.
Within the 12-month intervention, general practitioners (GPs) had three 30 min talks with each of their patients in addition to routine consultations. The first talk aimed at identifying treatment targets and priorities of the patient. During the second talk, the medication taken by the patient was discussed based on a 'brown bag' review of all the medications the patient had at home. The third talk served to discuss goal attainment and future treatment targets. GPs in the control group performed care as usual.
We assumed that the number of medications taken by the patient would be reduced by 1.5 substances in the intervention group and that the change in the intervention group's health-related quality of life would not be statistically significantly inferior to the control group.
The patients took a mean of 7.0±3.5 medications at baseline and 6.8±3.5 medications at follow-up. There was no difference between treatment and control group in the change of the number of medications taken (0.43; 95% CI -0.07 to 0.93; P=0.094) and no difference in health-related quality of life (0.03; -0.02 to 0.08; P=0.207). The likelihood of receiving a new prescription for analgesics was twice as high in the intervention group compared with the control group (risk ratio, 2.043; P=0.019), but the days spent in hospital were reduced by the intervention (-3.07; -5.25 to -0.89; P=0.006).
Intensifying the doctor-patient dialogue and discussing the patient's agenda and personal needs did not lead to a reduction of medication intake and did not alter health-related quality of life.
ISRCTN46272088; Pre-results.
确定以患者为中心的沟通方式是否能在不降低健康相关生活质量的情况下减少用药数量。
双臂整群随机对照试验。
德国汉堡、杜塞尔多夫和罗斯托克的55家初级医疗诊所。
604名65至84岁、患有至少三种慢性病的患者。
在为期12个月的干预期间，全科医生（GPs）除了进行常规会诊外，还与每位患者进行三次30分钟的交谈。第一次交谈旨在确定患者的治疗目标和优先事项。在第二次交谈中，根据对患者家中所有药物的“药袋”审查来讨论患者服用的药物。第三次交谈用于讨论目标达成情况和未来的治疗目标。对照组的全科医生照常提供护理。
我们假设干预组患者服用的药物数量将减少1.5种，且干预组健康相关生活质量的变化在统计学上不会显著低于对照组。
患者在基线时平均服用7.0±3.5种药物，随访时为6.8±3.5种药物。治疗组和对照组在服用药物数量的变化上没有差异（0.43；95%可信区间-0.07至0.93；P=0.094），在健康相关生活质量方面也没有差异（-0.03；-0.02至0.08；P=0.207）。与对照组相比，干预组接受新的镇痛药处方的可能性高出两倍（风险比，2.043；P=0.019），但干预使住院天数减少了（-3.07；-5.25至-0.89；P=0.006）。
加强医患对话并讨论患者的议程和个人需求并未导致用药量减少，也未改变健康相关生活质量。
ISRCTN46272088；预结果。
