JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
Sci Rep. 2018 Jul 9;8(1):10302. doi: 10.1038/s41598-018-28721-2.
The objective of this study is to evaluate if nurse-led repeated prescription (NRP) could ensure non-inferior disease control and would be accepted in Chinese patients with controlled hypertension (HT) in primary care clinics. A 12-month follow-up non-inferiority randomized trial was conducted. The non-inferior margins for systolic and diastolic blood pressure were 6.6 mmHg and 3.7 mmHg, respectively. Eligible patients (>18 years of age) with HT were randomized to the NRP and usual care (UC) groups for their regular clinical follow-up. We used ANCOVA to study the difference-of-difference of the blood pressures between the two groups. The levels of patient acceptance and experience of NRP were assessed by the observed opt-out rate and a qualitative analysis. We found no statistically significant differences in BP blood pressure between the NRP (N = 194) and UC (N = 199) groups. Only 4 of the participants in the NRP group opted out due to a preference for assessment by a physician. The interviewed participants (N = 12) felt positive about NRP, because they experienced more relaxed communication with the nurse and believed that the eligibility to join the NRP program was an indication of optimal BP control. We observed no adverse events. The findings show that NRP was well accepted and found to be non-inferior to physician consultation for HT management.
本研究旨在评估护士主导的重复处方(NRP)是否能确保疾病控制不劣于、并被中国基层医疗诊所中接受血压控制的高血压(HT)患者所接受。这是一项为期 12 个月的随访非劣效性随机试验。收缩压和舒张压的非劣效性边界分别为 6.6mmHg 和 3.7mmHg。符合条件的(年龄>18 岁)HT 患者被随机分配到 NRP 和常规护理(UC)组,以便进行常规临床随访。我们使用协方差分析(ANCOVA)来研究两组间血压的差异。通过观察退出率和定性分析来评估患者对 NRP 的接受程度和体验。我们发现 NRP 组(N=194)和 UC 组(N=199)之间的血压无统计学差异。由于对医生评估的偏好,NRP 组只有 4 名参与者选择退出。接受访谈的参与者(N=12)对 NRP 持积极态度,因为他们与护士的沟通更加轻松,并认为有资格参加 NRP 计划表明血压控制处于最佳状态。我们未观察到不良事件。研究结果表明,NRP 得到了很好的接受,并且在 HT 管理方面被发现不劣于医生咨询。