健康相关生活质量的决定因素：使用维生素 K 拮抗剂的医生管理抗凝患者的横断面研究。
Determinants of health-related quality of life: a cross-sectional investigation in physician-managed anticoagulated patients using vitamin K antagonists.
机构信息
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, Italy.
Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy.
出版信息
Health Qual Life Outcomes. 2020 Mar 16;18(1):73. doi: 10.1186/s12955-020-01326-y.
BACKGROUND
Literature has paid little attention in describing the specific contribution of each modifiable and non-modifiable characteristics on health-related quality of life (HRQoL) in physician-managed anticoagulated patients using vitamin K antagonists (VKAs). To describe how patients' treatment-specific knowledge, health literacy, treatment beliefs, clinical, and socio-demographic characteristics influence HRQoL in Italian physician-managed anticoagulated patients using VKAs.
METHODS
Cross-sectional multicentre study with a consecutive sampling strategy, enrolling 164 long-term anticoagulated patients. Clinical and socio-demographic characteristics were collected from electronic medical records. Valid and reliable questionnaires were used to collect patients' treatment-specific knowledge, health literacy, beliefs about VKAs, physical and health perceptions.
RESULTS
Obtaining and understanding health information (i.e., communicative health literacy) positively predicts both adequate mental (OR = 10.9; 95%CI = 1.99-19.10) and physical (OR = 11.54; 95%CI = 1.99-34.45) health perceptions. Conversely, the ability to perform proper health decision making (i.e., critical health literacy) was associated with lower rates of adequate mental health perception (OR = 0.13; 95%CI = 0.03-0.63). Further, age negatively predicted physical health perception (OR = 0.87; 95%CI = 0.81-0.93).
CONCLUSIONS
Health literacy plays an interesting role in predicting HRQoL. The relationship between critical health literacy and mental health perception could be influenced by some psychological variables, such as distress and frustration, which could be present in patients with higher levels of critical health literacy, as they could be more inclined for self-monitoring. For this reason, future research are needed to identify the most suitable patients' profile for each OAC-management model, by longitudinally describing the predictive performance of each modifiable and non-modifiable determinant of HRQoL.
背景
文献在描述使用维生素 K 拮抗剂 (VKA) 的医生管理抗凝患者的健康相关生活质量 (HRQoL) 方面，对可改变和不可改变特征的具体贡献关注甚少。本研究旨在描述意大利医生管理使用 VKA 的抗凝患者中，患者的治疗相关知识、健康素养、治疗信念、临床和社会人口统计学特征如何影响 HRQoL。
方法
采用连续抽样策略的横断面多中心研究，纳入 164 名长期抗凝患者。从电子病历中收集临床和社会人口统计学特征。使用有效和可靠的问卷收集患者的治疗相关知识、健康素养、对 VKA 的信念、身体和健康感知。
结果
获取和理解健康信息（即沟通健康素养）正向预测充分的心理（OR=10.9；95%CI=1.99-19.10）和身体（OR=11.54；95%CI=1.99-34.45）健康感知。相反，进行适当健康决策的能力（即批判性健康素养）与充分的心理健康感知率较低相关（OR=0.13；95%CI=0.03-0.63）。此外，年龄负向预测身体健康感知（OR=0.87；95%CI=0.81-0.93）。
结论
健康素养在预测 HRQoL 方面发挥着重要作用。批判性健康素养与心理健康感知之间的关系可能受到一些心理变量的影响，例如焦虑和沮丧，这些变量可能存在于批判性健康素养较高的患者中，因为他们可能更倾向于自我监测。因此，需要进行未来的研究来确定每种 OAC 管理模式的最合适患者特征，通过纵向描述 HRQoL 的每个可改变和不可改变决定因素的预测性能。
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