基于跨理论模型的干预和动机性访谈对COVID-19大流行期间血液透析患者通过远程医疗进行高磷血症管理的影响（TMT项目）

Effect of a transtheoretical model-based intervention and motivational interviewing on hyperphosphatemia management via telehealth (TMT program) among hemodialysis patients during the COVID-19 pandemic.

作者信息

Thongsunti Arrom, Silpakit Chatchawan, Rattananupong Thanapoom, Kittanamongkolchai Wonngarm, Sumethpimolchai Warangkana, Lohsoonthorn Vitool

机构信息

Health Research and Management Program, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Front Public Health. 2024 Nov 20;12:1361778. doi: 10.3389/fpubh.2024.1361778. eCollection 2024.

DOI:10.3389/fpubh.2024.1361778

PMID:39668955

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11636525/

Abstract

BACKGROUND

Hyperphosphatemia poses a significant risk for cardiovascular diseases and mortality in hemodialysis patients. Non-adherence to phosphate binders and a low-phosphate diet behavior contribute to this issue. Leveraging psychological and behavior change theories has proven effective in addressing many health risks. During the COVID-19 pandemic, face-to-face communication was limited, and telehealth served as a bridge to address healthcare gaps. This study aimed to determine the effect of a transtheoretical model-based intervention and motivational interviewing on hyperphosphatemia management via telehealth (TMT program) among hemodialysis patients during the COVID-19 pandemic.

METHOD

A two-arm parallel randomized controlled trial with assessors blinding involved 80 participants who were stratified block-randomized into either the TMT program group ( = 40) or the control group (Usual care; = 40). Linear regression was used to compare the two groups on serum phosphorus levels, knowledge of hyperphosphatemia management, and dietary consumption behavior at the 24-week endpoint. The readiness to change (stage of change), self-efficacy, and phosphate binder adherence were assessed using Fisher's test.

RESULT

The TMT program demonstrated a significant reduction in serum phosphorus levels compared to usual care (mean difference = -1.03, 95% CI = -1.77, -0.29). Additionally, improvement in dietary consumption behavior related to phosphorus-containing foods was also observed (mean difference = 13.48, 95% CI = 8.41, 18.57). Positive effects emerged in the readiness to change ( < 0.001), self-efficacy in the appropriate use of phosphate binders ( = 0.025), and adherence to phosphate binders ( = 0.001) at the 24-week endpoint. However, groups did not differ in knowledge of hyperphosphatemia management (mean difference = 7.02, 95% CI = -1.03, 15.07).

CONCLUSION

The study demonstrated that the TMT program has positive effects on reducing serum phosphorus levels, providing a hyperphosphatemia management strategy for ESRD patients undergoing hemodialysis via telehealth.

CLINICAL TRIAL REGISTRATION

TCTR20230628003, https://www.thaiclinicaltrials.org.

摘要

背景

高磷血症对血液透析患者的心血管疾病和死亡率构成重大风险。不坚持使用磷结合剂和低磷饮食行为导致了这一问题。利用心理和行为改变理论已被证明在应对许多健康风险方面是有效的。在新冠疫情期间，面对面交流受限，远程医疗成为解决医疗差距的桥梁。本研究旨在确定基于跨理论模型的干预和动机性访谈通过远程医疗对新冠疫情期间血液透析患者高磷血症管理的影响（TMT项目）。

方法

一项双臂平行随机对照试验，评估者设盲，纳入80名参与者，通过分层区组随机分为TMT项目组（n = 40）或对照组（常规护理；n = 40）。在24周终点时，使用线性回归比较两组的血清磷水平、高磷血症管理知识和饮食消费行为。使用Fisher检验评估改变的意愿（改变阶段）、自我效能感和磷结合剂依从性。

结果

与常规护理相比，TMT项目显示血清磷水平显著降低（平均差异 = -1.03，95%CI = -1.77，-0.29）。此外，还观察到与含磷食物相关的饮食消费行为有所改善（平均差异 = 13.48，95%CI = 8.41，18.57）。在24周终点时，改变的意愿（P < 0.001）、正确使用磷结合剂的自我效能感（P = 0.025）和磷结合剂依从性（P = 0.001）出现了积极影响。然而，两组在高磷血症管理知识方面没有差异（平均差异 = 7.02，95%CI = -1.03，15.07）。