van Tuyl Lilian H D, Plass Anne Marie C, Lems Willem F, Voskuyl Alexandre E, Kerstens Pit J S M, Dijkmans Ben A C, Boers Maarten
Department of Rheumatology, EMGO Institute, and the Department of Epidemiology and Biostatistics, VU University Medical Center, 1081 HV Amsterdam, The Netherlands.
J Rheumatol. 2009 Jul;36(7):1380-6. doi: 10.3899/jrheum.081078. Epub 2009 Jun 1.
COBRA combination therapy is well known and has uncontested efficacy in the treatment of rheumatoid arthritis (RA). However, it is infrequently applied in Dutch clinical practice. Based on qualitative research on opinions of physicians and patients towards COBRA therapy, our study describes the development and pilot testing of an implementation package to facilitate prescription and use of COBRA therapy in early RA.
The implementation package was developed to address specific barriers towards prescription of COBRA therapy and comprised informational handouts (an information booklet and leaflet for patients), preprinted prescription orders, and background information on COBRA therapy for the rheumatologists. Twenty-two rheumatologists agreed to participate, including the arthritis nurse where available. Rheumatologists, nurses, and patients were asked to record their experience. All Dutch arthritis nurses were invited to an educational session on COBRA therapy.
Sixteen rheumatologists accompanied by 10 arthritis nurses used the material to prescribe COBRA therapy to a total of 27 patients. Rheumatologists and nurses both gave high marks to the supplied materials. Eighty-eight percent of rheumatologists reported that the material sped up the prescription process, and 65% indicated they would prescribe COBRA therapy more frequently if these materials were available routinely. Patients expressed great satisfaction with the information handouts, rating it 2.8 (standard deviation 0.5) on a scale of -3 (very negative) to +3 (very positive). Most patients (89%) planned to keep the information booklet as a reference and 70% used it as a tool to remember the correct intake of medication. The attitude and perceived capability of nurses towards the guidance of patients with RA receiving COBRA therapy was improved through a brief educational intervention.
Rheumatologists, patients, and arthritis nurses all highly appreciated the implementation package and indicated that its availability would increase uptake of COBRA therapy.
COBRA联合疗法在类风湿关节炎（RA）治疗中广为人知且疗效确凿。然而，该疗法在荷兰临床实践中却很少应用。基于对医生和患者关于COBRA疗法看法的定性研究，我们的研究描述了一个实施包的开发和试点测试情况，该实施包旨在促进COBRA疗法在早期RA中的处方开具和使用。
开发该实施包是为了解决COBRA疗法处方开具方面的特定障碍，它包括信息手册（一本患者信息手册和传单）、预印的处方单以及给风湿病学家的关于COBRA疗法的背景信息。22名风湿病学家同意参与，如有可用的关节炎护士也包括在内。要求风湿病学家、护士和患者记录他们的体验。所有荷兰关节炎护士都被邀请参加关于COBRA疗法的教育课程。
16名风湿病学家在10名关节炎护士的陪同下使用这些材料为总共27名患者开具了COBRA疗法。风湿病学家和护士对所提供的材料都给予了高度评价。88%的风湿病学家报告称这些材料加快了处方开具过程，65%的人表示如果能常规获得这些材料，他们会更频繁地开具COBRA疗法。患者对信息手册非常满意，在从-3（非常负面）到+3（非常正面）的量表上给出了2.8（标准差0.5）的评分。大多数患者（89%）计划保留信息手册作为参考，70%的患者将其用作记住正确服药方法的工具。通过简短的教育干预，护士对接受COBRA疗法的RA患者指导的态度和感知能力得到了改善。
风湿病学家、患者和关节炎护士都高度赞赏该实施包，并表示其可用性将增加COBRA疗法的采用率。
