Clinical trial of interactive and videotaped educational interventions reduce infection, reactive depression, and rehospitalizations for sepsis in patients on home parenteral nutrition.
BACKGROUND
Patients receiving long-term home parenteral nutrition (HPN) have catheter-related infections, reactive depression, and other recurrent problems that decrease their quality of life. The aim of this study was to evaluate the Interactive Educational Videotaped Interventions (IEVI) designed to prevent HPN complications of catheter-related bloodstream infection (CR-BSI), to prevent reactive depression (from Diagnostic and Statistical Manual of Mental Disorders, 4th Edition definition), and to increase patients' frequency of problem-solving with professionals.


METHODS
A randomized placebo-controlled clinical trial was used to test IEVI that engaged patients in infection and depression prevention and problem-solving activities with professionals. The primary outcome measure was CR-BSIs, while reactive depression and problem solving were secondary outcomes. Quality of life and satisfaction with interventions, also secondary outcomes, were evaluated at 18 months.


RESULTS
Compared with controls, there was a lower frequency in the experimental group of CRBSIs (chi2 = 4.82, p = .03), reactive depression (chi2 = 4.50, p = .03), and rehospitalization for CR-BSIs (chi2 = 5.73, p = .01). There was greater use of problem solving in the experimental group (chi2 = 4.33, p = .038). These differences occurred at the primary endpoint of 6 months after administration of the interventions. At the 18-month follow-up, there were fewer CR-BSIs (chi2 = 4.42, p = .035), and fewer hospitalizations for infection (chi2 = 5.729, p = .01).


CONCLUSIONS
The IEVI reduced CR-BSIs and reactive depression and increased problem solving with professionals. IEVI use also can result in fewer hospitalizations and improved quality of life. Long-term improvement did not occur for reactive depression and problem-solving outcomes because patients used these less often.
Smith
Carol E
CE
University of Kansas Medical Center, Lenexa, USA.
Curtas
Susan
S
Kleinbeck
Susan V M
SV
Werkowitch
Marilyn
M
Mosier
Michael
M
Seidner
Douglas L
DL
Steiger
Ezra
E
D000293:Adolescent; D000328:Adult; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D003863:Depression / Q000209:etiology / Q000517:prevention & control*; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D006760:Hospitalization; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects; D010353:Patient Education as Topic / Q000379:methods; D011340:Problem Solving; D011788:Quality of Life; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014743:Videotape Recording