出院准备服务对老年慢性病患者干预效果的系统评价

目的系统评价出院准备服务对老年慢性病患者的干预效果。方法计算机检索CNKI、WanFang Data、VIP、Web of Science、The Cochrane Library、PubMed和EMbase数据库,搜集关于老年慢性病患者出院准备服务的随机对照试验(RCT),检索时限均从2000年1月至2019年1月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入7个RCT,包括884例患者。Meta分析结果显示:实施出院准备服务后,老年慢性病患者的急性并发症发生率RR=0.38,95%CI(0.15,0.98),P=0.04]下降,患者遵医行为SMD=0.54,95%CI(0.25,0.83),P=0.000 3]、运动能力SMD=2.65,95%CI(0.25,5.04),P=0.03]、护理满意度SMD=0.71,95%CI(0.10,1.33),P=0.02]均有提高。但两组因急性并发症导致再入院率RR=0.25,95%CI(0.06,1.11),P=0.07]、自我护理能力SMD=2.18,95%CI(-1.02,5.38),P=0.18]、日常生活活动能力(ADL)SMD=0.56,95%CI(-0.47,1.59),P=0.28]的差异无统计学意义。结论当前证据显示,实施出院准备服务后,老年慢性病患者的急性并发症发生率更少,遵医行为、运动能力、护理满意度得到了提高。但受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Efficacy of discharge preparation service on intervention of elderly patients with chronic diseases: a systematic review

Objective To systematically review the efficacy of discharge preparation service in elderly patients with chronic diseases. Methods CNKI, WanFang Data, VIP, Web of Science, The Cochrane Library, PubMed and EMbase databases were electronically searched to collect randomized controlled trails(RCTs) on the discharge preparation service for elderly patients with chronic diseases from January, 2000 to January, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 7 RCTs, involving 884 patients were included. The results of meta-analysis showed that: after the hospitalization preparation service, the incidence of acute complication(RR=0.38,95%CI 0.15 to 0.98, P=0.04), patient compliance behavior(SMD=0.54, 95% CI 0.25 to 0.83, P=0.000 3), exercise capacity(SMD=2.65, 95%CI 0.25 to 5.04, P=0.03), and nursing satisfaction(SMD=0.71, 95%CI 0.10 to 1.33, P=0.02) significantly improved. However, there were no significant differences in emergency hospital admission for acute complications(RR=0.25, 95%CI 0.06 to 1.11, P=0.07), self-care ability(SMD=2.18, 95%CI-1.02 to 5.38, P=0.18), activity of daily living(ADL)(SMD=0.56, 95%CI-0.47 to 1.59, P=0.28). Conclusions The current evidence shows that after implementation of the discharge preparation service, the incidence of acute complication, compliance behavior, exercise ability, and service satisfaction of the elderly patients with chronic diseases are significantly improved. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusion.