基于数字平台的以患者为中心的护理和结构化电话支持对慢性阻塞性肺疾病和慢性心力衰竭患者的影响：随机对照试验。
Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial.
机构信息
Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.
出版信息
J Med Internet Res. 2021 Dec 13;23(12):e26794. doi: 10.2196/26794.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are characterized by severe symptom burden and common acute worsening episodes that often require hospitalization and affect prognosis. Although many studies have shown that person-centered care (PCC) increases self-efficacy in patients with chronic conditions, studies on patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalization in these patients are scarce.
OBJECTIVE
The aim of this study is to evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF.
METHODS
A multicenter randomized trial was conducted from 2018 to 2020. A total of 222 patients were recruited from 9 primary care centers. Patients diagnosed with COPD, CHF, or both and with internet access were eligible. Participants were randomized into either usual care (112/222, 50.5%) or PCC combined with usual care (110/222, 49.5%). The intervention's main component was a personal health plan cocreated by the participants and assigned health care professionals. The health care professionals called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary end point, divided into 2 categories (improved and deteriorated or unchanged), was a composite score of change in general self-efficacy and hospitalization or death 6 months after randomization. Data from the intention-to-treat group at 3- and 6-month follow-ups were analyzed. In addition, a per-protocol analysis was conducted on the participants who used the intervention.
RESULTS
No significant differences were found in composite scores between the groups at the 3- and 6-month follow-ups. However, the per-protocol analysis of the 3-month follow-up revealed a significant difference in composite scores between the study groups (P=.047), although it was not maintained until the end of the 6-month follow-up (P=.24). This effect was driven by a change in general self-efficacy from baseline.
CONCLUSIONS
PCC using a combined digital platform and structured telephone support seems to be an option to increase the short-term self-efficacy of people with COPD and CHF. This study adds to the knowledge of conceptual innovations in primary care to support patients with COPD and CHF.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03183817; http://clinicaltrials.gov/ct2/show/NCT03183817.
背景
慢性阻塞性肺疾病（COPD）和慢性心力衰竭（CHF）的特点是严重的症状负担和常见的急性恶化发作，这些发作往往需要住院治疗，并影响预后。尽管许多研究表明，以患者为中心的护理（PCC）可以提高慢性病患者的自我效能，但关于在初级保健中治疗 COPD 和 CHF 患者的 PCC 研究以及 PCC 对这些患者住院风险的影响却很少。
目的
本研究旨在通过结合数字平台和电话支持来评估 PCC 对 COPD 和 CHF 患者的影响。
方法
这是一项 2018 年至 2020 年进行的多中心随机试验。共有 222 名患者从 9 个初级保健中心招募。符合条件的患者被诊断患有 COPD、CHF 或两者兼有，并具备上网条件。参与者被随机分为常规护理组（112/222，50.5%）或 PCC 联合常规护理组（110/222，49.5%）。干预的主要组成部分是参与者和指定的医疗保健专业人员共同制定的个人健康计划。医疗保健专业人员在干预组中给参与者打电话，并通过 PCC 沟通技巧鼓励叙述来建立伙伴关系。数字平台被用作沟通工具。主要终点分为 2 类（改善和恶化或不变），是随机分组后 6 个月时一般自我效能感变化和住院或死亡的综合评分。对 3 个月和 6 个月随访的意向治疗组进行了数据分析。此外，还对使用干预措施的参与者进行了方案分析。
结果
在 3 个月和 6 个月的随访中，两组之间的综合评分没有显著差异。然而，3 个月随访的方案分析显示，研究组之间的综合评分存在显著差异（P=.047），尽管在 6 个月随访结束时并未保持（P=.24）。这种影响是由基线时一般自我效能感的变化驱动的。
结论
使用数字平台和结构化电话支持相结合的 PCC 似乎是增加 COPD 和 CHF 患者短期自我效能的一种选择。这项研究增加了初级保健中支持 COPD 和 CHF 患者的概念创新方面的知识。
试验注册
ClinicalTrials.gov NCT03183817；http://clinicaltrials.gov/ct2/show/NCT03183817。
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