干预措施和背景因素对改善初级保健中高血压患者护理保留率的影响：解释学系统评价。

Interventions and contextual factors to improve retention in care for patients with hypertension in primary care: Hermeneutic systematic review.

机构信息

Weill Cornell Medicine, NY, New York, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA.

出版信息

Prev Med. 2024 Mar;180:107880. doi: 10.1016/j.ypmed.2024.107880. Epub 2024 Jan 30.

DOI:10.1016/j.ypmed.2024.107880

PMID:38301908

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10919242/

Abstract

BACKGROUND

Regular engagement over time in hypertension care, or retention, is a crucial but understudied step in optimizing patient outcomes. This systematic review leverages a hermeneutic methodology to identify, evaluate, and quantify the effects of interventions and contextual factors for improving retention for patients with hypertension.

METHODS

We searched for articles that were published between 2000 and 2022 from multiple electronic databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and WHO International Trials Registry. We followed the latest version of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline to report the findings for this review. We also synthesized the findings using a hermeneutic methodology for systematic reviews, which used an iterative process to review, integrate, analyze, and interpret evidence.

RESULTS

From 4686 screened titles and abstracts, 18 unique studies from 9 countries were identified, including 10 (56%) randomized controlled trials (RCTs), 3 (17%) cluster RCTs, and 5 (28%) non-RCT studies. The number of participants ranged from 76 to 1562. The overall mean age range was 41-67 years, and the proportion of female participants ranged from 0% to 100%. Most (n = 17, 94%) studies used non-physician personnel to implement the proposed interventions. Fourteen studies (78%) implemented multilevel combinations of interventions. Education and training, team-based care, consultation, and Short Message Service reminders were the most common interventions tested.

CONCLUSIONS

This review presents the most comprehensive findings on retention in hypertension care to date and fills the gaps in the literature, including the effectiveness of interventions, their components, and contextual factors. Adaptation of and implementing HIV care models, such differentiated service delivery, may be more effective and merit further study.

REGISTRATION

CRD42021291368.

PROTOCOL REGISTRATION

PROSPERO 2021 CRD42021291368. Available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291368.

摘要

背景

在高血压治疗中，定期持续参与（即保留）是优化患者结局的关键步骤，但这一环节却鲜有研究。本系统综述利用阐释学方法，确定、评估和量化了改善高血压患者保留率的干预措施和背景因素的效果。

方法

我们从多个电子数据库（包括 MEDLINE、EMBASE、Cochrane 中央对照试验注册中心、clinicaltrials.gov 和世卫组织国际临床试验注册平台）中搜索了 2000 年至 2022 年期间发表的文章。我们遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南的最新版本报告本综述的结果。我们还使用阐释学系统评价方法综合研究结果，该方法使用迭代过程来审查、整合、分析和解释证据。

结果

从 4686 篇筛选出的标题和摘要中，确定了来自 9 个国家的 18 项独特研究，包括 10 项（56%）随机对照试验（RCT）、3 项（17%）整群 RCT 和 5 项（28%）非 RCT 研究。参与者人数从 76 人到 1562 人不等。总体平均年龄范围为 41-67 岁，女性参与者比例从 0%到 100%不等。大多数（n=17，94%）研究使用非医师人员来实施所提出的干预措施。14 项研究（78%）实施了多层次的干预组合。教育和培训、团队护理、咨询和短信提醒是测试过的最常见干预措施。