摘要：

背景 

慢性病共病患者需要有效的初級(jí)衛(wèi)生保健服務(wù)。

目的

評(píng)估為時(shí)6周的小組OPTIMAL干預(yù)方案（以職業(yè)療法為主的自我管理支持干預(yù)）對(duì)慢性病共病患者自我管理的影響。

設(shè)計(jì)和開(kāi)展地點(diǎn)

本研究為實(shí)效性平行隨機(jī)對(duì)照試驗(yàn)，由8個(gè)全科醫(yī)療小組自2015年11月至2018年12月在愛(ài)爾蘭東部149例慢性病共病患者中開(kāi)展，以比較OPTIMA干預(yù)方案和常規(guī)療法改善患者自我管理的效果。

方法

主要結(jié)局指標(biāo)為采用EQ-5D-3L量表評(píng)價(jià)的健康相關(guān)生活質(zhì)量和Frenchay活動(dòng)指數(shù)（FAI）評(píng)價(jià)的活動(dòng)參加次數(shù)。次要結(jié)局指標(biāo)為日常生活活動(dòng)能力、工作表現(xiàn)和滿意度、焦慮和抑郁、自我效能和醫(yī)療服務(wù)利用情況。對(duì)具有完整資料的患者療效進(jìn)行線性分析，并按照年齡（<65/≥65歲）和慢性病數(shù)量（<4/≥4）進(jìn)行亞組分析。

結(jié)果

在干預(yù)后即刻隨訪和干預(yù)后6個(gè)月隨訪時(shí)分別有124例(83.2%)和212例(81.2%)患者具有完整的資料。干預(yù)后即刻隨訪發(fā)現(xiàn)，干預(yù)組患者EQ-VAS評(píng)分有顯著改善[aMD= 7.86，95%CI（0.92～14.80）]。但是兩組患者EQ-5D-3L 指數(shù)評(píng)分  [aMD = 0.04, 95%CI(?0.06～0.13)] 和Frenchay活動(dòng)指數(shù)評(píng)分[aMD = 1.22, 95%CI (?0.84～3.29)] 無(wú)顯著差異。干預(yù)后6個(gè)月隨訪發(fā)現(xiàn)，兩組患者主要結(jié)局指標(biāo)無(wú)顯著性差異。同時(shí)，混合效應(yīng)分析表明，兩組患者的次要結(jié)局指標(biāo)也無(wú)顯著性差異。預(yù)設(shè)亞組分析表明年齡大于65歲的患者從OPTIMA干預(yù)方案獲益的可能性更大。

結(jié)論

本研究發(fā)現(xiàn)，慢性病共病患者接受OPTIMA方案干預(yù)6個(gè)月后，該方案在改善患者健康相關(guān)生活質(zhì)量或活動(dòng)參與方面無(wú)效。同時(shí)，現(xiàn)有干預(yù)方案更側(cè)重于高齡慢性病共病患者。預(yù)設(shè)亞組分析建議未來(lái)相關(guān)研究應(yīng)針對(duì)低于65歲的患者。

 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.

翻譯：李秀娟

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