Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Infection. 2023 Dec;51(6):1787-1795. doi: 10.1007/s15010-023-02088-7. Epub 2023 Sep 1.
To determine whether a novel intervention improves the adherence to guideline-based preventive measures in asplenic patients at risk of post-splenectomy sepsis (PSS).
We used a prospective controlled, two-armed historical control group design to compare a novel, health action process approach (HAPA)-based telephonic intervention involving both patients and their general practitioners to usual care. Eligible patients were identified in cooperation with the insurance provider AOK Baden-Wuerttemberg, Germany. Patients with anatomic asplenia (n = 106) were prospectively enrolled and compared to a historical control group (n = 113). Comparisons were done using a propensity-score-based overlap-weighting model. Adherence to preventive measures was quantified by the study-specific 'Preventing PSS score' (PrePSS score) which includes pneumococcal and meningococcal vaccination status, the availability of a stand-by antibiotic and a medical alert card.
At six months after the intervention, we estimated an effect of 3.96 (95% CI 3.68-4.24) points on the PrePSS score scale (range 0-10) with mean PrePSS scores of 3.73 and 7.70 in control and intervention group, respectively. Substantial improvement was seen in all subcategories of the PrePSS score with the highest absolute gains in the availability of stand-by antibiotics. We graded the degree of participation by the general practitioner (no contact, short contact, full intervention) and noted that the observed effect was only marginally influenced by the degree of physician participation.
Patients who had received the intervention exhibited a significantly higher adherence to guideline-based preventive measures compared to the control group. These data suggest that widespread adoption of this pragmatic intervention may improve management of asplenic patients. Health insurance provider-initiated identification of at-risk patients combined with a patient-focused intervention may serve as a blueprint for a wide range of other preventive efforts leading to patient empowerment and ultimately to better adherence to standards of care.
确定一种新的干预措施是否能提高接受脾切除术的易发生脾切除后感染（PSS）风险的患者对基于指南的预防措施的依从性。
我们采用前瞻性对照、双臂历史对照组设计，将基于健康行动过程方法（HAPA）的电话干预措施（包括患者及其全科医生）与常规护理进行比较。德国巴登-符腾堡州 AOK 保险公司合作确定符合条件的患者。前瞻性招募解剖性无脾患者（n=106）并与历史对照组（n=113）进行比较。使用基于倾向评分重叠加权模型进行比较。预防 PSS 评分（PrePSS 评分）用于量化预防措施的依从性，该评分包括肺炎球菌和脑膜炎球菌疫苗接种情况、备用抗生素的可用性和医疗警示卡。
干预后 6 个月，我们估计干预组的 PrePSS 评分（范围 0-10）增加了 3.96（95%CI 3.68-4.24）分，对照组和干预组的平均 PrePSS 评分分别为 3.73 和 7.70。PrePSS 评分的所有亚类别均有显著改善，备用抗生素的可用性方面的绝对改善最大。我们根据全科医生的参与程度（无接触、短接触、全面干预）对参与程度进行了分级，并注意到观察到的效果仅受到医生参与程度的轻微影响。
与对照组相比，接受干预的患者对基于指南的预防措施的依从性显著提高。这些数据表明，广泛采用这种实用的干预措施可能会改善无脾患者的管理。医疗保险提供商发起的高危患者识别与以患者为中心的干预相结合，可以为广泛的其他预防措施提供蓝图，从而增强患者的自主权，最终提高对护理标准的依从性。
