PDF(Pubmed)
Abstract：
OBJECTIVE: To determine whether a novel intervention improves the adherence to guideline-based preventive measures in asplenic patients at risk of post-splenectomy sepsis (PSS).
METHODS: We used a prospective controlled, two-armed historical control group design to compare a novel, health action process approach (HAPA)-based telephonic intervention involving both patients and their general practitioners to usual care. Eligible patients were identified in cooperation with the insurance provider AOK Baden-Wuerttemberg, Germany. Patients with anatomic asplenia (n = 106) were prospectively enrolled and compared to a historical control group (n = 113). Comparisons were done using a propensity-score-based overlap-weighting model. Adherence to preventive measures was quantified by the study-specific \'Preventing PSS score\' (PrePSS score) which includes pneumococcal and meningococcal vaccination status, the availability of a stand-by antibiotic and a medical alert card.
RESULTS: At six months after the intervention, we estimated an effect of 3.96 (95% CI 3.68-4.24) points on the PrePSS score scale (range 0-10) with mean PrePSS scores of 3.73 and 7.70 in control and intervention group, respectively. Substantial improvement was seen in all subcategories of the PrePSS score with the highest absolute gains in the availability of stand-by antibiotics. We graded the degree of participation by the general practitioner (no contact, short contact, full intervention) and noted that the observed effect was only marginally influenced by the degree of physician participation.
CONCLUSIONS: Patients who had received the intervention exhibited a significantly higher adherence to guideline-based preventive measures compared to the control group. These data suggest that widespread adoption of this pragmatic intervention may improve management of asplenic patients. Health insurance provider-initiated identification of at-risk patients combined with a patient-focused intervention may serve as a blueprint for a wide range of other preventive efforts leading to patient empowerment and ultimately to better adherence to standards of care.
METHODS: We used a prospective controlled, two-armed historical control group design to compare a novel, health action process approach (HAPA)-based telephonic intervention involving both patients and their general practitioners to usual care. Eligible patients were identified in cooperation with the insurance provider AOK Baden-Wuerttemberg, Germany. Patients with anatomic asplenia (n = 106) were prospectively enrolled and compared to a historical control group (n = 113). Comparisons were done using a propensity-score-based overlap-weighting model. Adherence to preventive measures was quantified by the study-specific \'Preventing PSS score\' (PrePSS score) which includes pneumococcal and meningococcal vaccination status, the availability of a stand-by antibiotic and a medical alert card.
RESULTS: At six months after the intervention, we estimated an effect of 3.96 (95% CI 3.68-4.24) points on the PrePSS score scale (range 0-10) with mean PrePSS scores of 3.73 and 7.70 in control and intervention group, respectively. Substantial improvement was seen in all subcategories of the PrePSS score with the highest absolute gains in the availability of stand-by antibiotics. We graded the degree of participation by the general practitioner (no contact, short contact, full intervention) and noted that the observed effect was only marginally influenced by the degree of physician participation.
CONCLUSIONS: Patients who had received the intervention exhibited a significantly higher adherence to guideline-based preventive measures compared to the control group. These data suggest that widespread adoption of this pragmatic intervention may improve management of asplenic patients. Health insurance provider-initiated identification of at-risk patients combined with a patient-focused intervention may serve as a blueprint for a wide range of other preventive efforts leading to patient empowerment and ultimately to better adherence to standards of care.
摘要：
目的：确定一种新的干预措施是否能改善存在脾切除术后脓毒症（PSS）风险的脾患者对基于指南的预防措施的依从性。
方法：我们使用前瞻性对照，双臂历史控制组设计比较小说，基于健康行动过程方法（HAPA）的电话干预，涉及患者及其全科医生的日常护理。与保险提供者AOK巴登-符腾堡州合作确定了符合条件的患者，德国。前瞻性纳入解剖性脾患者（n=106），并与历史对照组（n=113）进行比较。使用基于倾向得分的重叠加权模型进行比较。通过研究特定的“预防PSS评分”（PrePSS评分）对预防措施的依从性进行量化，其中包括肺炎球菌和脑膜炎球菌疫苗接种状态，备用抗生素和医疗警报卡的可用性。
结果：干预后六个月，我们估计在PrePSS评分量表（范围0-10）上有3.96（95％CI3.68-4.24）分的影响，对照组和干预组的平均PrePSS评分为3.73和7.70，分别。在PrePSS评分的所有子类别中都看到了显着改善，在备用抗生素的可用性方面绝对收益最高。我们对全科医生的参与程度进行了评级(没有联系，短接触,全面干预），并指出观察到的效果仅受到医生参与程度的影响很小。
结论：与对照组相比，接受干预的患者对基于指南的预防措施的依从性明显更高。这些数据表明，广泛采用这种实用干预措施可能会改善脾患者的管理。健康保险提供者发起的对有风险患者的识别与以患者为中心的干预措施相结合，可以作为广泛的其他预防工作的蓝图，从而使患者赋权并最终更好地遵守护理标准。
方法：我们使用前瞻性对照，双臂历史控制组设计比较小说，基于健康行动过程方法（HAPA）的电话干预，涉及患者及其全科医生的日常护理。与保险提供者AOK巴登-符腾堡州合作确定了符合条件的患者，德国。前瞻性纳入解剖性脾患者（n=106），并与历史对照组（n=113）进行比较。使用基于倾向得分的重叠加权模型进行比较。通过研究特定的“预防PSS评分”（PrePSS评分）对预防措施的依从性进行量化，其中包括肺炎球菌和脑膜炎球菌疫苗接种状态，备用抗生素和医疗警报卡的可用性。
结果：干预后六个月，我们估计在PrePSS评分量表（范围0-10）上有3.96（95％CI3.68-4.24）分的影响，对照组和干预组的平均PrePSS评分为3.73和7.70，分别。在PrePSS评分的所有子类别中都看到了显着改善，在备用抗生素的可用性方面绝对收益最高。我们对全科医生的参与程度进行了评级(没有联系，短接触,全面干预），并指出观察到的效果仅受到医生参与程度的影响很小。
结论：与对照组相比，接受干预的患者对基于指南的预防措施的依从性明显更高。这些数据表明，广泛采用这种实用干预措施可能会改善脾患者的管理。健康保险提供者发起的对有风险患者的识别与以患者为中心的干预措施相结合，可以作为广泛的其他预防工作的蓝图，从而使患者赋权并最终更好地遵守护理标准。
