通过远程医疗和个体化患者教育进行二级预防风险干预（SPRITE）：改善心肌梗死后管理的随机试验。

Secondary Prevention Risk Interventions via Telemedicine and Tailored Patient Education (SPRITE): A randomized trial to improve post myocardial infarction management.

机构信息

Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States.

University of Texas Southwest, Dallas TX United States.

出版信息

Patient Educ Couns. 2022 Sep;105(9):2962-2968. doi: 10.1016/j.pec.2022.05.011. Epub 2022 May 18.

DOI:10.1016/j.pec.2022.05.011

PMID:35618550

Abstract

OBJECTIVE

We evaluated the impact of a low intensity web-based and intensive nurse-administered intervention to reduce systolic blood pressure (SBP) among patients with prior MI.

METHODS

Secondary Prevention Risk Interventions via Telemedicine and Tailored Patient Education (SPRITE) was a three-arm trial. Patients were randomized to 1) post-MI education-only; 2) nurse-administered telephone program; or 3) web-based interactive tool. The study was conducted 2009-2013.

RESULTS

Participants (n = 415) had a mean age of 61 years (standard deviation [SD], 11). Relative to the education-only group, the 12-month differential improvement in SBP was - 3.97 and - 3.27 mmHg for nurse-administered telephone and web-based groups, respectively. Neither were statistically significant. Post hoc exploratory subgroup analyses found participants who received a higher dose (>12 encounters) in the nurse-administered telephone intervention (n = 60; 46%) had an 8.8 mmHg (95% CI, 0.69, 16.89; p = 0.03) differential SBP improvement versus low dose (<11 encounters; n = 71; 54%). For the web-based intervention, those who had higher dose (n = 73; 53%; >1 web encounter) experienced a 2.3 mmHg (95% CI, -10.74, 6.14; p = 0.59) differential SBP improvement versus low dose (n = 65; 47%).

CONCLUSIONS

The main effects were not statistically significant.

PRACTICAL IMPLICATIONS

Completing the full dose of the intervention may be essential to experience the intervention effect.

CLINICAL TRIAL REGISTRATION

The unique identifier is NCT00901277 (http://www.

CLINICALTRIALS

gov/ct2/show/NCT00901277?term=NCT00901277&rank=1).

摘要

目的

我们评估了一项低强度网络和强化护士管理干预措施对既往心肌梗死患者收缩压（SBP）的影响。

方法

二级预防风险干预通过远程医疗和个体化患者教育（SPRITE）是一个三臂试验。患者被随机分为 1）心肌梗死后教育仅组；2）护士管理电话程序组；或 3）基于网络的互动工具组。该研究于 2009 年至 2013 年进行。

结果

参与者（n=415）的平均年龄为 61 岁（标准差[SD]，11）。与教育仅组相比，护士管理电话和基于网络组在 12 个月时 SBP 的差异改善分别为-3.97mmHg 和-3.27mmHg。两者均无统计学意义。事后探索性亚组分析发现，接受护士管理电话干预更高剂量（>12 次）的参与者（n=60；46%）的 SBP 改善有 8.8mmHg（95%CI，0.69，16.89；p=0.03），与低剂量（<11 次；n=71；54%）相比。对于基于网络的干预，那些接受更高剂量（n=73；53%；>1 次网络接触）的患者经历了 2.3mmHg（95%CI，-10.74，6.14；p=0.59）的 SBP 差异改善，与低剂量（n=65；47%）相比。