一项基于健康素养的干预对慢性阻塞性肺疾病（COPD）患者住院、健康素养、自我管理、生活质量和医疗费用影响的随机对照试验。

Impacts of a health literacy-informed intervention in people with chronic obstructive pulmonary disease (COPD) on hospitalization, health literacy, self-management, quality of life, and health costs - A randomized controlled trial.

机构信息

Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Lovisenberg Diaconal Hospital, Oslo, Norway.

Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Lovisenberg Diaconal University College, Oslo, Norway.

出版信息

Patient Educ Couns. 2024 Jun;123:108220. doi: 10.1016/j.pec.2024.108220. Epub 2024 Feb 16.

DOI:10.1016/j.pec.2024.108220

PMID:38458089

Abstract

OBJECTIVE

To compare the effect of motivational interviewing (MI) and tailored health literacy (HL) follow-up with usual care on hospitalization, costs, HL, self-management, Quality of life (QOL), and psychological stress in people with chronic obstructive pulmonary disease (COPD).

METHODS

A RCT was undertaken in Norway between March 2018-December 2020 (n = 127). The control group (CG, n = 63) received usual care. The intervention group (IG, n = 64) received tailored HL follow-up from MI-trained COPD nurses with home visits for eight weeks and phone calls for four months after hospitalization. Primary outcomes were hospitalization at eight weeks, six months, and one year from baseline. The trial was registered with ClinicalTrials.gov (NCT03216603) and analysed per protocol.

RESULTS

Compared with the IG, the CG had 2.8 higher odds (95% CI [1.3 to 5.8]) of hospitalization and higher hospital health costs (MD=€ -6230, 95% CI [-6510 to -5951]) and lower QALYs (MD=0.1, 95% CI [0.10 to 0.11]) that gives an ICER = - 62,300. The IG reported higher QOL, self-management, and HL (p = 0.02- to <0.01).

CONCLUSION

MI-trained COPD nurses using tailored HL follow-up is cost-effective, reduces hospitalization, and increases QOL, HL, and self-care in COPD.

PRACTICE IMPLICATION

Tailored HL follow-up is beneficial for individuals with COPD and the healthcare system.

摘要

目的

比较动机访谈（MI）和量身定制的健康素养（HL）随访与常规护理对慢性阻塞性肺疾病（COPD）患者住院、费用、HL、自我管理、生活质量（QOL）和心理压力的影响。

方法

2018 年 3 月至 2020 年 12 月，挪威进行了一项 RCT（n=127）。对照组（CG，n=63）接受常规护理。干预组（IG，n=64）接受由接受过 MI 培训的 COPD 护士进行的量身定制的 HL 随访，包括住院后 8 周的家访和 4 个月的电话随访。主要结局为从基线开始的 8 周、6 个月和 1 年的住院率。该试验在 ClinicalTrials.gov （NCT03216603）上注册，并按照方案进行分析。

结果

与 IG 相比，CG 的住院风险高出 2.8 倍（95%CI[1.3 至 5.8]），住院健康费用更高（MD=-6230 欧元，95%CI[-6510 至-5951]），QALYs 更低（MD=0.1，95%CI[0.10 至 0.11]），这意味着增量成本效益比为-62300 欧元。IG 报告的 QOL、自我管理和 HL 更高（p=0.02 至 <0.01）。