强化患者教育可提高医师在急性冠状动脉综合征后遵循指南推荐的药物治疗的依从性。
Reinforcement of patient education improved physicians' adherence to guideline-recommended medical therapy after acute coronary syndrome.
机构信息
Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
出版信息
PLoS One. 2019 Jun 6;14(6):e0217444. doi: 10.1371/journal.pone.0217444. eCollection 2019.
BACKGROUND
Prescription of guideline-recommended medicines after acute coronary syndrome (ACS) has been suboptimal. Tools for improving the use of medications have been developed, but they mainly targeted physicians.
OBJECTIVE
We evaluated the effects of reinforcement of patient and family education on the usage of guideline-recommended secondary prevention medications.
METHODS
This was a retrospective analysis of a prospectively collected registry of patients with ACS who were admitted to a regional teaching hospital in Taiwan between February 2015 and April 2017. The control group included 76 patients discharged before implementing the electronic-based patient and family education (PFE) system. The intervention group included 206 patients discharged after implementation. The primary outcome was the prescription rate of all four guideline-recommended drugs. Predictors of adherence were also evaluated.
RESULTS
The study cohort included 282 ACS patients (188 men and 94 women) with a mean age of 68.5 years (standard deviation, 14.2). The intervention group patients were younger, had more family history of premature cardiovascular disease, more dyslipidemia, and underwent more reperfusion therapy. The intervention group was prescribed more guideline-recommended drugs than the control group: dual antiplatelet agents, 79.61% vs. 47.37% (p<0.001); statins, 74.76% vs. 34.21% (p<0.001); beta-blockers, 81.07% vs. 46.05% (p<0.001); angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, 62.62% vs. 38.16% (p<0.001); and a combination of all four medications, 39.32% vs. 14.47% (p<0.001). After adjusting baseline variables, the PFE system remained a significant contributor to adherence to these drugs use (P = 0.02).
CONCLUSIONS
Reinforcement of patient education was associated with significant improvements in physicians' adherence to guideline-recommended medical therapy after acute coronary syndrome.
背景
急性冠状动脉综合征（ACS）后，指南推荐药物的处方并不理想。已经开发出改善药物使用的工具，但它们主要针对医生。
目的
我们评估了加强患者和家庭教育对指南推荐的二级预防药物使用的影响。
方法
这是对 2015 年 2 月至 2017 年 4 月期间在台湾一家地区教学医院住院的 ACS 患者前瞻性收集的登记处进行的回顾性分析。对照组包括在实施基于电子的患者和家庭教育（PFE）系统之前出院的 76 名患者。干预组包括实施后出院的 206 名患者。主要结局是所有四种指南推荐药物的处方率。还评估了依从性的预测因素。
结果
研究队列包括 282 名 ACS 患者（188 名男性和 94 名女性），平均年龄为 68.5 岁（标准差为 14.2）。干预组患者年龄较小，有更多的早发性心血管疾病家族史，更多的血脂异常，并且接受了更多的再灌注治疗。与对照组相比，干预组患者开具了更多的指南推荐药物：双联抗血小板药物，79.61%比 47.37%（p<0.001）；他汀类药物，74.76%比 34.21%（p<0.001）；β受体阻滞剂，81.07%比 46.05%（p<0.001）；血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂，62.62%比 38.16%（p<0.001）；以及所有四种药物的联合使用，39.32%比 14.47%（p<0.001）。调整基线变量后，PFE 系统仍然是医生遵守这些药物使用的重要因素（P = 0.02）。
结论
加强患者教育与急性冠状动脉综合征后医生遵循指南推荐的医学治疗方案显著改善相关。
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