OPTIMAL干预方案对基层慢性病共病患者自我管理的影响：一项随机对照试验

摘要：

背景 

慢性病共病患者需要有效的初级卫生保健服务。

目的

评估为时6周的小组OPTIMAL干预方案（以职业疗法为主的自我管理支持干预）对慢性病共病患者自我管理的影响。

设计和开展地点

本研究为实效性平行随机对照试验，由8个全科医疗小组自2015年11月至2018年12月在爱尔兰东部149例慢性病共病患者中开展，以比较OPTIMA干预方案和常规疗法改善患者自我管理的效果。

方法

主要结局指标为采用EQ-5D-3L量表评价的健康相关生活质量和Frenchay活动指数（FAI）评价的活动参加次数。次要结局指标为日常生活活动能力、工作表现和满意度、焦虑和抑郁、自我效能和医疗服务利用情况。对具有完整资料的患者疗效进行线性分析，并按照年龄（<65/≥65岁）和慢性病数量（<4/≥4）进行亚组分析。

结果

在干预后即刻随访和干预后6个月随访时分别有124例(83.2%)和212例(81.2%)患者具有完整的资料。干预后即刻随访发现，干预组患者EQ-VAS评分有显著改善[aMD= 7.86，95%CI（0.92～14.80）]。但是两组患者EQ-5D-3L 指数评分  [aMD = 0.04, 95%CI(−0.06～0.13)] 和Frenchay活动指数评分[aMD = 1.22, 95%CI (−0.84～3.29)] 无显著差异。干预后6个月随访发现，两组患者主要结局指标无显著性差异。同时，混合效应分析表明，两组患者的次要结局指标也无显著性差异。预设亚组分析表明年龄大于65岁的患者从OPTIMA干预方案获益的可能性更大。

结论

本研究发现，慢性病共病患者接受OPTIMA方案干预6个月后，该方案在改善患者健康相关生活质量或活动参与方面无效。同时，现有干预方案更侧重于高龄慢性病共病患者。预设亚组分析建议未来相关研究应针对低于65岁的患者。

 https://doi.org/10.3399/bjgp20X714185

原文摘要如下：

Effect of the OPTIMAL programme on self-management of multimorbidity in primary care: a randomised controlled trial | British Journal of General Practice

Abstract

Background Effective primary care interventions for multimorbidity are needed.

Aim To evaluate the effectiveness of a group-based, 6-week, occupational therapy-led self-management support programme (OPTIMAL) for patients with multimorbidity.

Design and setting A pragmatic parallel randomised controlled trial across eight primary care teams in Eastern Ireland with 149 patients with multimorbidity, from November 2015 to December 2018. Intervention was OPTIMAL with a usual care comparison.

Method Primary outcomes were health-related quality of life (EQ-5D-3L) and frequency of activity participation (Frenchay Activities Index [FAI]). Secondary outcomes included independence in activities of daily living, occupational performance and satisfaction, anxiety and depression, self-efficacy, and healthcare utilisation. Complete case linear regression analyses were conducted. Age (<65/≥65 years) and the number of chronic conditions (<4/≥4) were explored further.

Results A total of 124 (83.2%) and 121 (81.2%) participants had complete data at immediate and 6-month post-intervention follow-up, respectively. Intervention participants had significant improvement in EQ-VAS (visual analogue scale) at immediate follow-up (adjusted mean difference [aMD] = 7.86; 95% confidence interval [CI] = 0.92 to 14.80) but no difference in index score (aMD = 0.04; 95% CI = −0.06 to 0.13) or FAI (aMD = 1.22; 95% CI = −0.84 to 3.29). At 6-month follow-up there were no differences in primary outcomes and mixed results for secondary outcomes. Pre-planned subgroup analyses suggested participants aged <65 years were more likely to benefit.

Conclusion OPTIMAL was found to be ineffective in improving health-related quality of life or activity participation at 6-month follow-up. Existing multimorbidity interventions tend to focus on older adults; preplanned subgroup analyses results in the present study suggest that future research should target younger adults (<65 years) with multimorbidity.

翻译：李秀娟

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