Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 1, 2021
Date Accepted: Jul 26, 2021
The Web-Based Integrated-Management Program Improves Medication Adherence, Quality of Life, and Readmission in Patients with Atrial Fibrillation: A Randomized Controlled Trial.
ABSTRACT
Background:
Atrial fibrillation (AF) is related to a variety of chronic diseases and life-threatening complications. It is estimated that by 2050, there will be 72 million AF patients in Asia, of which 2.9 million will have AF-associated stroke. AF has become a major issue for health care systems.
Objective:
we aimed to evaluate the effects of the Web-Based Integrated-Management Program on improving coping strategies, medication adherence, and health-related quality of life (HRQoL) in patients with AF, and to detect the effect on decreasing readmission events.
Methods:
The parallel-group, double-blind, prospective randomized controlled trial recruited patients with AF from a medical center in northern Taiwan and divided them randomly into intervention and control groups. Patients in the intervention group received the Web-Based Integrated-Management Program, while in the control group received usual care. The measurements included Brief COPE, Medication Adherence Rating Scale (MARS), the 3-level version of EuroQol five-dimension self-report questionnaire (EQ-5D-3L), and readmission events two years after initiating the intervention. Data were collected at four times (baseline, 1 month, 3 months, and 6 months after initiating the intervention), and analyzed with generalized estimating equations.
Results:
Total of 231 patients were divided into intervention (n=115) and control (n=116) groups. The mean age of participants was 73.08 ± 11.71 years. Most participants were diagnosed with paroxysmal AF (74%), and the most frequent comorbidity was hypertension (70.1%). Compared with controls, the intervention group showed significantly greater improvement in approach coping strategies, medication adherence and HRQoL at 1, 3 and 6 months (all, P < .05). In addition, the intervention group showed significantly fewer readmission events within two years (OR= 0.406, P =.032), compared with the control group.
Conclusions:
The Web-Based Integrated-Management Program can significantly improve patients' coping strategy and medication adherence. Therefore, it can empower patients to maintain disease stability, which is a major factor in improving their HRQoL and reducing readmission events within two years. Clinical Trial: NCT04813094
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