TY - JOUR AU - Piette, John D AU - Striplin, Dana AU - Marinec, Nicolle AU - Chen, Jenny AU - Trivedi, Ranak B AU - Aron, David C AU - Fisher, Lawrence AU - Aikens, James E PY - 2015 DA - 2015/06/10 TI -支持心力衰竭患者和他们的非正式照顾者的移动健康干预:随机比较有效性试验JO - J Med Internet Res SP - e142 VL - 17 IS - 6kw -远程保健KW -移动保健KW -心力衰竭KW -疾病管理KW -自我管理AB -背景:移动保健(mHealth)干预可能改善心力衰竭(HF)自我护理，但标准模型没有解决非正式护理人员对患者状态信息或护理人员如何提供帮助的需求。目的:我们评估了心衰患者看护者的移动健康支持超过标准移动健康方法的影响。方法:我们确定了331名来自退伍军人事务部门诊的心衰患者。所有患者都在他们的家庭之外找到了一个“护理伙伴”。随机分配到“标准移动健康”(n=165)组的患者接受了为期12个月的每周交互式语音应答(IVR)电话，包括关于他们的健康和自我管理的问题。根据患者的反馈，他们收到了量身定制的自我管理建议，他们的临床团队收到了关于严重健康问题的结构化传真警报。随机分配到“mHealth+CP”组(n=166)的患者接受了相同的干预，但在每次IVR呼叫后都会自动发送电子邮件给他们的CarePartner，包括关于患者状态的反馈和CarePartner如何支持疾病护理的建议。自我护理和症状通过6个月和12个月的电话调查与研究助理。通过每周IVR评估收集自我护理和症状数据。 Results: Participants were on average 67.8 years of age, 99% were male (329/331), 77% where white (255/331), and 59% were married (195/331). During 15,709 call-weeks of attempted IVR assessments, patients completed 90% of their calls with no difference in completion rates between arms. At both endpoints, composite quality of life scores were similar across arms. However, more mHealth+CP patients reported taking medications as prescribed at 6 months (8.8% more, 95% CI 1.2-16.5, P=.02) and 12 months (13.8% more, CI 3.7-23.8, P<.01), and 10.2% more mHealth+CP patients reported talking with their CarePartner at least twice per week at the 6-month follow-up (P=.048). mHealth+CP patients were less likely to report negative emotions during those interactions at both endpoints (both P<.05), were consistently more likely to report taking medications as prescribed during weekly IVR assessments, and also were less likely to report breathing problems or weight gains (all P<.05). Among patients with more depressive symptoms at enrollment, those randomized to mHealth+CP were more likely than standard mHealth patients to report excellent or very good general health during weekly IVR calls. Conclusions: Compared to a relatively intensive model of IVR monitoring, self-management assistance, and clinician alerts, a model including automated feedback to an informal caregiver outside the household improved HF patients’ medication adherence and caregiver communication. mHealth+CP may also decrease patients’ risk of HF exacerbations related to shortness of breath and sudden weight gains. mHealth+CP may improve quality of life among patients with greater depressive symptoms. Weekly health and self-care monitoring via mHealth tools may identify intervention effects in mHealth trials that go undetected using typical, infrequent retrospective surveys. Trial Registration: ClinicalTrials.gov NCT00555360; https://clinicaltrials.gov/ct2/show/NCT00555360 (Archived by WebCite at http://www.webcitation.org/6Z4Tsk78B). SN - 1438-8871 UR - //www.mybigtv.com/2015/6/e142/ UR - https://doi.org/10.2196/jmir.4550 UR - http://www.ncbi.nlm.nih.gov/pubmed/26063161 DO - 10.2196/jmir.4550 ID - info:doi/10.2196/jmir.4550 ER -