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一项系统评价研究考察了以社区为基础的针对慢性病老年患者的自我管理项目是否能积极参与并教授患者以患者为导向的自我管理策略。

A systematic review examining whether community-based self-management programs for older adults with chronic conditions actively engage participants and teach them patient-oriented self-management strategies.

机构信息

School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada.

School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada; Radboud University Medical Center and HAN University of Applied Sciences, Nijmegen, the Netherlands.

出版信息

Patient Educ Couns. 2019 Dec;102(12):2162-2182. doi: 10.1016/j.pec.2019.07.002. Epub 2019 Jul 2.

Abstract

OBJECTIVE

To identify whether community-based Self-Management Programs (SMPs) actively engaged, or taught, individuals patient-oriented strategies; and whether having these attributes led to significant differences in outcomes.

METHODS

This systematic review included randomized controlled trials (RCTs)and cluster RCTs reporting on community-based SMPs with a group component for older adults with chronic conditions. The ways SMPS actively engaged participants and whether they taught patient-oriented strategies were analyzed. All study outcomes were reported.

RESULTS

The 31 included studies demonstrated community-based SMP programs actively engaged participants and provided strategies to improve health behaviour or care of their condition. Few included strategies to help manage the impact of conditions on their everyday lives. Seventy-nine percent of studies reported significant differences; variations in sample sizes and outcomes made it difficult to conclude whether having these attributes led to significant differences.

CONCLUSION

SMPs are not supporting older adults to use strategies to address the impact of conditions on their everyday lives, addressing the needs of older adults with multiple conditions, nor assessing outcomes that align with the strategies taught.

PRACTICE IMPLICATIONS

Health-care providers delivering SMPs to older adults need to tailor programs to the needs of older adults and assess whether participants are using strategies being proposed.

摘要

目的

确定基于社区的自我管理计划(SMP)是否积极参与或教授个人以患者为导向的策略;以及这些属性是否导致结果存在显著差异。

方法

本系统评价纳入了随机对照试验(RCT)和群组随机对照试验(cluster RCT),报告了针对患有慢性病的老年人的基于社区的 SMP 群体组成部分。分析了 SMP 积极参与参与者的方式以及他们是否教授以患者为导向的策略。报告了所有研究结果。

结果

31 项纳入研究表明,基于社区的 SMP 计划积极参与了参与者,并提供了改善健康行为或疾病管理的策略。很少有研究提供帮助管理疾病对日常生活影响的策略。79%的研究报告了显著差异;样本量和结果的差异使得难以得出这些属性是否导致显著差异的结论。

结论

SMP 并未支持老年人使用策略来解决疾病对日常生活的影响,也未满足患有多种疾病的老年人的需求,也未评估与所教授策略一致的结果。

实践意义

向老年人提供 SMP 的医疗保健提供者需要根据老年人的需求调整计划,并评估参与者是否正在使用所提出的策略。

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