ACP发布新手册以降低冠脉事件后再入院率

旧金山——美国医师协会(ACP)发布了新的免费印刷版医患指导手册，旨在降低因急性冠脉事件住院后大约20%的再入院率。

在ACP2013年会上，该手册起草小组组长Doron Schneider博士称，研究表明，在因心脏病发作或不稳定性心绞痛等急性冠脉事件住院的患者中，出院后7天内接受1次随访可降低患者的再入院率。这份新手册可以帮助患者顺利完成从医院到家庭再到第1次出院后随访的过渡，也有助于医生充分准备以便最大程度地发挥出院后随访的作用。他说，之前的急性冠脉事件患者手册没有解决这一关键的过渡期，只是就如何保护心脏健康提供了一般性建议。

ACP首席执行官Steven E. Weinberger博士说，近年来降低治疗成本的呼声越来越高，新手册可以帮助医生通过减少再住院次数来降低成本。“这类患者的再住院风险非常高。”

临床医生可以从ACP官网上下载或者索取这份新手册。下周将在YouTube和ACP官网上公布补充视频材料，其中一个视频应该在患者出院前或出院后马上观看，另一个视频则重点涉及药物治疗。Schneider博士指出，许多患者在急性冠脉事件后“并没有领取第一张处方上的药品或者没有遵医嘱用药”。

作为美国宾夕法尼亚州阿宾顿纪念医院的首席患者安全和质量官员，Schneider博士称，这份22页的患者手册采用了大字体的简单排版，并且提供了检查表，这说明了ACP在制定这份手册时始终是以患者为中心。起草小组对4组过去1年内出现过急性冠脉综合征事件的患者及其配偶或重要家属进行了调查，以了解患者及其家属想要了解哪些知识。该手册的语言通俗易懂，图片均来自真实的患者。

2页的医生手册则罗列了首次出院后随访应该解决的核心问题，并且建议了一些具体的步骤以确认主要问题已经涉及。例如，建议早上交班时在患者前来接受首次随访之前先确认患者的病历资料是否完整，包括出院小结、出院指导以及出院时尚未拿到的实验室检查结果。

患者手册首先介绍了“我的身体出现了什么问题？”，然后讨论患者如何才能管理好自己的健康状况，如何才能保持健康。6页纸是针对患者用药，预留的页面可供患者写下自己的服药情况，并且检查自己为何要停药或换药。还有4页纸涉及患者的恢复情况，包括自身感受、工作、活动以及性生活。“红色区域”描述的症状可以帮助患者决定其是否有必要拨打911求助，“黄色区域”提示患者何时需要给医生打电话，“绿色区域”则提示“正常”的情况。

此外，还有3张单独的检查表分别针对的是“出院前”、“到家时”以及“首次随访时”的注意事项。

新手册的制作由杨森制药公司资助。

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By: SHERRY BOSCHERT, Cardiology News Digital Network

SAN FRANCISCO – The American College of Physicians released new, free, print handouts for patients and clinicians to help reduce the approximately 20% rate of readmissions after hospitalizations for acute coronary events.

Studies have shown reduced readmission rates in patients who have a follow-up visit within 7 days of discharge for an acute coronary syndrome event such as a heart attacks or unstable angina.
 
The new tools should help patients transition from the hospital to home and then to the first post-discharge visit, and help clinicians be ready to make the most of the post-discharge visit, leaders of the American College of Physicians (ACP) said at the college’s annual meeting.

Previous handouts for patients with acute coronary events didn’t address this crucial transition, instead giving patients general tips on how to keep their hearts healthy, said Dr. Doron Schneider, a leader on the ACP team that created the tools.

For physicians, the tools could help them meet increasing expectations to reduce costs by reducing rehospitalizations. "These patients are at very high risk of readmission," said Dr. Steven E. Weinberger, ACP chief executive officer.

Clinicians can download the handouts or order copies through the ACP website. Videos to complement the tools should be posted on YouTube and the ACP site next week, one to be viewed before or shortly after leaving the hospital, and another focusing on medications. "Many patients don’t fill their first prescription or don’t adhere to their first prescription" after an acute coronary event, Dr. Schneider noted.

The 22-page patient pamphlet’s large print, simple layout, and checklists reflect the patient-centered approach that the ACP used in developing it. The group conducted four focus groups of patients who’d had an acute coronary syndrome event in the past year and their spouses or significant others, to find out what they felt patients and families needed to know. The pamphlet uses patients’ words and its photos are of real patients, said Dr. Schneider, chief patient safety and quality officer at Abington (Pa.) Memorial Hospital.

The two-page handout for clinicians lists core aspects to be addressed in the first post-hospitalization visit and suggests concrete steps to make sure the key areas get covered. For example, it suggests having a morning staff huddle to make sure patient charts have what’s needed before the patient arrives for the first follow-up visit, including a discharge summary, discharge instructions, and lab test results that were pending at the time of discharge.

The patient pamphlet starts with information on "What happened to me?" and discusses how patients can take charge of their health, and how to stay healthy.

Six pages are devoted to medicines, with room for patients to write down their own and check off reasons why they have stopped or changed any medicines.

Four pages discuss aspects of recovery, including feelings, work, activities, and sex. Symptoms described in a "Red Zone" help patients decide when they need to call 911, a "Yellow Zone" suggests when to call their doctors, and a "Green Zone" describes what "going well" looks like.

Three separate checklists help patients "Before you leave the hospital," "When you get home," and at "Your first follow-up visit."

A grant from Janssen Pharmaceuticals funded creation of the new tools.