摘要
目的探讨运用标准化个体治疗决策辅助工具管理心房颤动患者的可行性及成效。方法研究参照随机双盲对照试验方案,选取536例上海市宝山区淞南镇社区卫生服务中心全科门诊就诊的心房颤动(简称房颤)患者临床资料,采用随机数字法均分为对照组和研究组,每组268例。对照组予以传统方式于门诊就诊时对患者进行疾病诊疗与宣教,研究组使用标准化个体治疗手册对患者进行多维度疾病宣教。手册以循证学数据为依据,国内外各大房颤治疗指南为指导,以图文结合的形式表现。随访至少1年后比较两组房颤患者疾病知晓率、规范抗凝治疗率。结果536例患者中457例(85.3%)存在血栓栓塞中高风险,基线抗凝治疗有效患者150例,多因素logistic回归分析结果显示,低学历、男性、年龄<75岁是未接受抗凝治疗的重要影响因素(P<0.05),有三级医院专科就诊经历的患者抗凝治疗率更高(P<0.05)。对比不同宣教方法,宣教管理后研究组患者对疾病认知度显著高于对照组(P<0.001),规范抗凝治疗率显著高于对照组(P<0.001)。结论应用标准化个体治疗决策辅助工具对社区房颤患者进行门诊宣教管理有效、可行,能显著提高患者行标准化房颤治疗,尤其是抗凝治疗的比例。
Objective To explore the feasibility and effectiveness of standardized individual therapeutic decision aid in the management of patients with atrial fibrillation. Methods In this randomized double-blind controlled study, 536 outpatient with atrial fibrillation admitted to Songnan Community Health Service Center in Baoshan District, Shanghai, were selected and randomly divided into research group and control group(n=268). The control group received diagnosis, treatment and education through traditional strategy, while the research group received disease education through standardized individual treatment manuals. The manual was based on evidence-based data, guided by major domestic and foreign guidelines for the treatment of atrial fibrillation and presented in the combination of pictures and texts. The disease awareness rate and standardized anticoagulation rate were compared between the two groups after at least one-year follow-up. Results There were 457(85.3%) patients at medium or high risk of embolization.The effective anticoagulation at baseline was 150 cases. Multivariate logistic regression analysis showed that low-level educational background, male sex, and age <75 years were the important influencing factors for not receiving anticoagulation(P<0.05). The anticoagulation rate was higher in patients treated in specialized Grade Ⅲ general hospital(P<0.05). The patients in the research group had higher level of disease cognition and standardized anticoagulation rate than those in the control group(P<0.001). Conclusion It is effective and feasible to standardize individual management and guide patients with atrial fibrillation in community by using decision aid strategy.It can significantly improve standardized atrial fibrillation treatment rate, especially anticoagulation therapy.
作者
徐佶佶
周静
黄双庆
杜郁华
张俊峰
范虞琪
XU Jiji;ZHOU Jing;HUANG Shuangqing;DU Yuhua;ZHANG Junfeng;FAN Yuqi(Department of General Practice,Songnan Town Community Health Service Center,Baoshan District,Shanghai 200434,China;不详)
出处
《上海医学》
CAS
2022年第5期330-335,共6页
Shanghai Medical Journal
基金
上海市宝山区科学技术委员会科技创新项目(19-E-15),上海市“医苑新星”青年医学人才培养资助计划[沪卫计人事(2019)72号],上海市中西医学会社区医学与健康管理研究项目(2021-49)。
关键词
心房颤动
标准化个体治疗
决策工具
抗凝治疗
全科
Atrial fibrillation
Standardized individual therapy
Decision aid
Anticoagulation
General practice
