在初级保健诊所中，针对患有慢性病的老年患者的职业治疗干预的可行性和初步疗效。
Feasibility and Preliminary Efficacy of an Occupational Therapy Intervention for Older Adults With Chronic Conditions in a Primary Care Clinic.
机构信息
Mansha Mirza, PhD, OTR/L, MSHSOR, is Associate Professor, Department of Occupational Therapy, University of Illinois at Chicago;
Maureen Gecht-Silver, OTD, MPH, OTR/L, is Assistant Professor, Clinical Family Medicine and Clinical Occupational Therapy, and Associate Director, Medical Student Education, Department of Family Medicine, University of Illinois at Chicago.
出版信息
Am J Occup Ther. 2020 Sep/Oct;74(5):7405205030p1-7405205030p13. doi: 10.5014/ajot.2020.039842.
IMPORTANCE
Occupational therapy can play a role in primary care management of chronic diseases among older adults.
OBJECTIVE
To assess the feasibility of delivering a primary care occupation-focused intervention (Integrated PRimary care and Occupational therapy for Aging and Chronic disease Treatment to preserve Independence and Functioning, or i-PROACTIF) for older adults with chronic disease.
DESIGN
Feasibility study comparing i-PROACTIF with complex care management using a two-group randomized controlled trial design with data gathered at baseline and during and after the 8-wk intervention.
SETTING
Family medicine clinic serving an urban, low-income, working-class community.
OUTCOMES AND MEASURES
Feasibility indicators were recruitment, retention, utility of clinical assessments, and acceptability of interventions assessed through feedback surveys completed by patients and primary care providers (PCPs). Patient outcomes, including perspectives on chronic illness care, occupational performance, and overall well-being, were collected using standardized, validated measures and analyzed descriptively.
PARTICIPANTS
Eighteen adult volunteers, ages ≥50 yr, with heart disease, arthritis, and uncontrolled diabetes completed the study. Ten PCPs completed feedback surveys.
INTERVENTION
i-PROACTIF focuses on preserving functional independence, is based on the Person-Environment-Occupation framework, and consists of two assessment sessions and six weekly treatment sessions.
RESULTS
Recruitment goals were achieved, with an 86% retention rate. Clinical measures unearthed deficits in areas that were unreported or underreported by patients. Participants reported being extremely satisfied with the intervention. Physicians and nurses also supported the intervention. Both groups showed improved scores on most outcomes.
CONCLUSION AND RELEVANCE
Delivering and evaluating i-PROACTIF was feasible and acceptable. Future efficacy trials are needed before it can be used in clinical settings.
WHAT THIS ARTICLE ADDS
The results of this study can inform future occupational therapy interventions and clinical trials in primary care for older adults with chronic conditions.
重要性
职业治疗可以在老年人慢性病的初级保健管理中发挥作用。
目的
评估针对慢性病老年患者提供初级保健以职业为重点的干预措施（综合初级保健和职业治疗以维持老年人的健康和功能，或 i-PROACTIF）的可行性。
设计
使用两组成组随机对照试验设计，对 i-PROACTIF 与复杂护理管理进行比较，在基线和 8 周干预期间和之后收集数据。
设置
为服务于城市、低收入、工人阶级社区的家庭医学诊所。
结果和措施
可行性指标包括招募、保留率、临床评估的效用以及患者和初级保健提供者（PCP）通过反馈调查完成的干预措施的可接受性。使用标准化、经过验证的措施收集患者结果，包括对慢性病护理、职业表现和整体幸福感的看法，并进行描述性分析。
参与者
18 名年龄在 50 岁以上、患有心脏病、关节炎和未控制糖尿病的成年志愿者完成了研究。10 名 PCP 完成了反馈调查。
干预措施
i-PROACTIF 专注于保持功能独立性，基于人与环境-职业框架，包括两次评估会议和六次每周治疗会议。
结果
实现了招募目标，保留率为 86%。临床措施揭示了患者未报告或报告不足的领域的缺陷。参与者报告对干预措施非常满意。医生和护士也支持干预措施。两组在大多数结果上的得分都有所提高。
结论和相关性
提供和评估 i-PROACTIF 是可行且可接受的。在将其用于临床环境之前，需要进行未来的疗效试验。
这篇文章的添加内容
这项研究的结果可以为未来在初级保健中为患有慢性病的老年人提供职业治疗干预和临床试验提供信息。
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