A family nurse-led intervention for reducing health services’utilization in individuals with chronic diseases:The ADVICE pilot study  

通过家庭护士主导的健康教育减少慢性病患者就医的试点研究

作　　者：Serenella Savini Paolo Iovino Dario Monaco Roberta Marchini Tiziana Di Giovanni Giuseppe Donato Ausilia Pulimeno Carmela Matera Giuseppe Quintavalle Carlo Turci 

机构地区：[1]ASL Rome 4,Rome,Italy [2]Department of Biomedicine and Prevention,University of Rome Tor Vergata,Rome,Italy [3]School of Nursing,Midwifery and paramedicine Faculty of health sciences,Australian Catholic University,Melbourne,Australia [4]Presidente Ordine Professioni Infermieristiche,Rome,Italy

出　　处：《International Journal of Nursing Sciences》2021年第3期264-270,I0002,共8页国际护理科学（英文）

摘　　要：Objectives:Intensive health services'utilization is common in older individuals affected by chronic diseases.This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services'use(readmissions and/or emergency service access)among older people affected by chronic conditions.Methods:This is a non-randomized before-after pilot study.A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months.Standard home care was provided during the first four months'period(months 1-4),followed by the educational intervention until the end of the study(months 5-8).The intervention,based on the teach-back method,consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment,potential complications,medication adherence,and health behaviours.Rates of health services'use were collected immediately before(T0),and after the interventions(T1).Differences in utilization rates were examined by the McNemar's test.Potential factors associated with the risk of health services'use were explored with a Cox proportional hazard regression model.Results:The sample(n=78)was predominantly female(n=50,64.1%),and had a mean age of 76.2(SD=4.8)years.Diabetes mellitus was the most frequent disease(n=27,34.6%).McNemar's test indicated a significant reduction in health services'use at T1(McNemar χ^(2)==28.03,P<0.001).Cox regressions indicated that time and patient education,as well as their interaction,were the only variables positively associated with the probability of health services'use.Conclusion:A teach-back intervention led by a family nurse practitioner has the potential to reduce health services'use in older patients with chronic diseases.目的老年慢性病患者往往需要频繁得到医疗服务.这项研究旨在评估由家庭护士主导的结构化教育干预措施是否可以有效地减少受老年慢性病患者医疗服务使用(再入院和/或急救服务)频次.方法采用非随机前后对照研究.从意大利的2个综合性诊所招募了78例患者,其中70例完成了历时8个月的研究.前4个月进行了标准的居家护理,随后进行结构化教育干预,直至研究结束.基于回授法的教育干预包括每周1次60 min家庭会议,内容针对患者所患疾病及其治疗、潜在并发症、药物依从性和健康行为等方面.收集教育干预前后老年患者的医疗服务使用频率.采用McNemar检验分析教育干预前后医疗服务利用率的差异,通过Cox风险回归模型分析与医疗服务使用有关的潜在因素.结果本组(n=78)主要为女性(n=50,64.1%),平均年龄76.2(SD=4.8)岁.糖尿病是最常见的疾病(n=27,34.6%).McNemar分析结果表明,健康教育干预后患者医疗服务的使用频率明显减少(χ^(2)=28.03,P<0.001).Cox回归分析结果表明,时间和患者教育程度均与卫生服务使用概率有关,时间和患者教育程度的交互效应也与之存在关联.结论由家庭护士执业者主导的回授法教育干预措施有可能减少老年慢性病患者的医疗服务使用.

关 键 词：Aged Chronic disease Facilities and services utilization Family nurse practitioners Patient readmission Home care services Health services 

分 类 号：R473.5[医药卫生—护理学]