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沟通培训对全科医疗中高血压临床护理的影响：中国的一项群组随机对照试验。

The impact of communication training on the clinical care of hypertension in general practice: a cluster randomized controlled trial in China.

机构信息

General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, NO.37 Guoxue Lane, Wuhou District, Chengdu, 611130, China.

The Department of General Practice, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu City, China.

出版信息

BMC Prim Care. 2024 Mar 26;25(1):98. doi: 10.1186/s12875-024-02344-1.

DOI:10.1186/s12875-024-02344-1

PMID:38532356

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10964506/

Abstract

BACKGROUND

Hypertension is one of the most common chronic diseases with a low control rate globally. The effect of communication skills training contributing to hypertension control remains uncertain. The aim of the present study was to assess the effectiveness of an educational intervention based on the Calgary-Cambridge guide in improving hypertensive management.

METHODS

A cluster randomized controlled trial enrolled 27 general practitioners (GPs) and 540 uncontrolled hypertensive patients attending 6 community health centers in Chengdu, China. GPs allocated to the intervention group were trained by an online communication course and two face-to-face workshops based on Calgary-Cambridge guides. The primary outcome was blood pressure (BP) control rates and reductions in systolic and diastolic BP from baseline to 3 months. The secondary outcome was changes in GPs' communication skills after one month, patients' knowledge and satisfaction after 3 months. Bivariate analysis and the regression model assessed whether the health provider training improved outcomes.

RESULTS

After the communication training, the BP control rate was significantly higher (57.2% vs. 37.4%, p < 0.001) in the intervention groups. Compared to the control group, there was a significant improvement in GP's communication skills (13.0 vs 17.5, p < 0.001), hypertensive patients' knowledge (18.0 vs 20.0, p < 0.001), and systolic blood pressure (139.1 vs 134.7, p < 0.001) after 3 months of follow-up. Random effects least squares regression models showed significant interactions between the intervention group and time period in the change of GP's communication skills (Parameter Estimated (PE): 0.612, CI:0.310,0.907, p = 0.006), hypertensive patient's knowledge (PE:0.233, CI: 0.098, 0.514, p < 0.001), satisfaction (PE:0.495, CI: 0.116, 0.706, p = 0.004), SBP (PE:-0.803, CI: -1.327, -0.389, p < 0.001) and DBP (PE:-0.918, CI: -1.694, -0.634, p < 0.001), from baseline to follow-up.

CONCLUSION

Communication training based on the Calgary-Cambridge guide for GPs has shown to be an efficient way in the short term to improve patient-provider communication skills and hypertension outcomes among patients with uncontrolled BPs.

TRIAL REGISTRATION

The trial was registered on Chinese Clinical Trials Registry on 2019-04-03. (ChiCTR1900022278).

摘要

背景

高血压是一种最常见的慢性病，全球控制率较低。沟通技巧培训对高血压控制的效果仍不确定。本研究的目的是评估基于卡尔加里-剑桥指南的教育干预对高血压管理的有效性。

方法

采用整群随机对照试验，纳入中国成都 6 个社区卫生服务中心的 27 名全科医生（GP）和 540 名未控制的高血压患者。分配到干预组的 GP 接受了基于卡尔加里-剑桥指南的在线沟通课程和两次面对面研讨会的培训。主要结局是血压（BP）控制率以及收缩压和舒张压从基线到 3 个月的降低。次要结局是干预 1 个月后 GP 沟通技巧的变化、3 个月后患者的知识和满意度。双变量分析和回归模型评估了卫生提供者培训是否改善了结局。

结果

沟通培训后，干预组的 BP 控制率显著更高（57.2% vs. 37.4%，p < 0.001）。与对照组相比，GP 的沟通技巧（13.0 分 vs. 17.5 分，p < 0.001）、高血压患者的知识（18.0 分 vs. 20.0 分，p < 0.001）和收缩压（139.1 分 vs. 134.7 分，p < 0.001）在 3 个月的随访后均有显著改善。随机效应最小二乘回归模型显示，干预组与时间周期之间在 GP 沟通技巧变化方面存在显著交互作用（参数估计值（PE）：0.612，CI：0.310，0.907，p = 0.006），高血压患者的知识（PE：0.233，CI：0.098，0.514，p < 0.001）、满意度（PE：0.495，CI：0.116，0.706，p = 0.004）、SBP（PE：-0.803，CI：-1.327，-0.389，p < 0.001）和 DBP（PE：-0.918，CI：-1.694，-0.634，p < 0.001），从基线到随访。