门诊随访与电话访谈用于术后护理的比较：一项随机对照试验。
Outpatient visits versus telephone interviews for postoperative care: a randomized controlled trial.
作者信息
Thompson Jennifer C, Cichowski Sara B, Rogers Rebecca G, Qeadan Fares, Zambrano Julissa, Wenzl Cynthia, Jeppson Peter C, Dunivan Gena C, Komesu Yuko M
机构信息
University of New Mexico Department of Obstetrics and Gynecology, Division of Urogynecology, 2211 Lomas Blvd. NE, ACC-4th Floor, Albuquerque, NM, 87131, USA.
Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
出版信息
Int Urogynecol J. 2019 Oct;30(10):1639-1646. doi: 10.1007/s00192-019-03895-z. Epub 2019 Feb 19.
INTRODUCTION AND HYPOTHESIS
Our aim was to determine whether postoperative telephone follow-up was noninferior to in-person clinic visits based on patient satisfaction. Secondary outcomes were safety and clinical outcomes.
METHODS
Women scheduled for pelvic surgery were recruited from a single academic institution and randomized to clinic or telephone follow-up. The clinic group returned for visits 2, 6, and 12 weeks postoperatively and the telephone group received a call from a nurse at the same time intervals. Women completed the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) questionnaire, Pelvic Floor Distress Inventory (PFDI)-20, and pain scales prior to and 3 months postoperatively. Randomized patients who completed the S-CAHPS at 3 months were included for analysis. Sample size calculations, based on a 15% noninferiority limit in the S-CAHPS global assessment surgeon rating, required 100 participants, with power = 80% and alpha = 0.025.
RESULTS
From October 2016 to November 2017, 100 participants were consented, underwent surgery, were randomized, and included in the final analysis (clinic group n = 50, telephone group n = 50). Mean age was 58.5 ± 12.2 years. Demographic data and surgery type, dichotomized into outpatient and inpatient, did not differ between groups. The S-CAHPS global assessment surgeon rating from patients in the telephone group was noninferior to the clinic group (92 vs 88%, respectively, rated their surgeons 9 and10, with a noninferiority limit of 36.1; p = 0.006). Adverse events did not differ between groups (n = 26; 57% fclinic vs 43% telephone; p = 0.36). Patients in the telephone group did not require additional emergency room or primary care visits. Clinical outcome measures improved in both groups, with no differences (all p > 0.05).
CONCLUSIONS
Telephone follow-up after pelvic floor surgery results in noninferior patient satisfaction, without differences in clinical outcomes or adverse events. Telephone follow-up may improve healthcare quality and decrease patient and provider burden for postoperative care.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov , www.clinicaltrials.gov , NCT02891187.
引言与假设
我们的目的是基于患者满意度确定术后电话随访是否不劣于门诊亲自就诊随访。次要结果为安全性和临床结果。
方法
从一家学术机构招募计划进行盆腔手术的女性，并将其随机分为门诊随访组或电话随访组。门诊随访组在术后2周、6周和12周返回门诊就诊，电话随访组在相同时间间隔接到护士的电话。女性在术前和术后3个月完成医疗服务提供者与系统消费者评估外科护理调查问卷（S-CAHPS）、盆底困扰量表（PFDI）-20以及疼痛量表。纳入在3个月时完成S-CAHPS的随机分组患者进行分析。基于S-CAHPS全球评估中外科医生评分15%的非劣效性界限进行样本量计算，需要100名参与者，检验效能=80%，α=0.025。
结果
2016年10月至2017年11月，100名参与者同意参与研究、接受手术、被随机分组并纳入最终分析（门诊随访组n = 50，电话随访组n = 50）。平均年龄为58.5±12.2岁。两组之间的人口统计学数据和手术类型（分为门诊手术和住院手术）无差异。电话随访组患者的S-CAHPS全球评估外科医生评分不劣于门诊随访组（分别为92%和88%将其外科医生评为9分和10分，非劣效性界限为36.1；p = 0.006）。两组之间不良事件无差异（n = 26；门诊随访组57%，电话随访组43%；p = 0.36）。电话随访组患者无需额外前往急诊室或初级保健机构就诊。两组的临床结局指标均有所改善，无差异（所有p>0.05）。
结论
盆底手术后电话随访的患者满意度不劣于门诊随访，临床结局和不良事件无差异。电话随访可能提高医疗质量，并减轻患者和医护人员术后护理的负担。
临床试验注册
ClinicalTrials.gov，www.clinicaltrials.gov，NCT02891187 。
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