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新冠疫情期间远程指导对心力衰竭患者风险降低行为的影响

Impact of Tele-Coaching During the COVID-19 Pandemic on Risk-Reduction Behavior of Patients with Heart Failure.

作者信息

Knoll Katharina, Leiter Sarah M, Rosner Stefanie, Trenkwalder Teresa, Erben Amadea, Kloss Christian, Bregenhorn Patrick, Schunkert Heribert, Reinhard Wibke

机构信息

Deutsches Herzzentrum München (German Heart Centre Munich), Cardiology Department, Technical University Munich, Munich, Germany.

German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany.

出版信息

Telemed J E Health. 2022 Jun;28(6):823-831. doi: 10.1089/tmj.2021.0324. Epub 2021 Oct 7.

Abstract

Our study assessed the effectiveness of tele-coaching over written information in educating patients with chronic heart failure (CHF) at high risk of hospitalization about corona virus disease 2019 (COVID-19). We analyzed the impact on number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and self-reported behavior change. In April 2020, a tele-coaching module and written summary about COVID-19, risk-reduction measures for prevention of COVID-19, and appropriate consultation of medical attention during the pandemic were integrated into an established tele-coaching program. Three hundred seventy-eight patients who had received both tele-coaching and written information 3 weeks earlier were interviewed using a structured questionnaire and compared with 1,748 patients who had only received written information at this point. Tele-coaching had no short-term effect on numbers of SARS-CoV-2 infections. However, patients receiving tele-coaching reported significantly more behavioral changes, including increased room ventilation (88% vs. 78%, < 0.0001), surface cleaning (80% vs. 70%,  = 0.0006), wearing of face masks (59% vs. 51%,  = 0.013), and reduced usage of public transport (77% vs. 68%,  = 0.0003), despite no observed difference in recall about risk-reduction measures. Moreover, tele-coaching improved patients' knowledge about how to seek medical help in an emergency (46% vs. 36%,  = 0.0006), with a significant reduction in self-reported doctors' appointments (304 vs. 413 per 1,000 patients,  = 0.002) and hospital visits (50 vs. 87 per 1,000,  = 0.033) during the first peak of the pandemic. In a population of patients with CHF at high risk of hospitalization, COVID-19-specific tele-coaching effectively supported behavioral changes and significantly reduced face-to-face medical contacts in a short-term follow-up period.

摘要

我们的研究评估了远程指导与书面信息相比,在教育有高住院风险的慢性心力衰竭(CHF)患者关于2019冠状病毒病(COVID-19)方面的有效性。我们分析了对严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染数量和自我报告行为改变的影响。2020年4月,一个关于COVID-19、预防COVID-19的风险降低措施以及疫情期间适当就医咨询的远程指导模块和书面总结被纳入一个既定的远程指导项目。对三周前同时接受远程指导和书面信息的378名患者使用结构化问卷进行访谈,并与此时仅接受书面信息的1748名患者进行比较。远程指导对SARS-CoV-2感染数量没有短期影响。然而,接受远程指导的患者报告的行为改变明显更多,包括增加房间通风(88%对78%,<0.0001)、表面清洁(80%对70%,=0.0006)、佩戴口罩(59%对51%,=0.013)以及减少公共交通使用(77%对68%,=0.0003),尽管在对风险降低措施的回忆方面没有观察到差异。此外,远程指导提高了患者在紧急情况下寻求医疗帮助的知识(46%对36%,=0.0006),在疫情第一个高峰期间,自我报告的医生预约显著减少(每1000名患者中304次对413次,=0.002),医院就诊次数也显著减少(每1000名患者中50次对87次,=0.033)。在有高住院风险的CHF患者群体中,针对COVID-19的远程指导在短期随访期间有效支持了行为改变,并显著减少了面对面医疗接触。

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