在二级护理日常实践中，风湿病临床护理专家在优化手部骨关节炎管理方面的作用：一项观察性研究。
Role of rheumatology clinical nurse specialists in optimizing management of hand osteoarthritis during daily practice in secondary care: an observational study.
机构信息
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
出版信息
J Multidiscip Healthc. 2011;4:403-11. doi: 10.2147/JMDH.S25269. Epub 2011 Nov 1.
BACKGROUND
The purpose of this study was to describe the effectiveness of a single one-hour consultation by a clinical nurse specialist in patients with hand osteoarthritis during daily rheumatology practice in secondary care.
METHODS
Consecutive patients diagnosed by rheumatologists to have primary hand osteoarthritis and referred to the clinical nurse specialist were eligible for entry into this study. The standardized 1-hour consultation consisted of assessments and education on hand osteoarthritis by a clinical nurse specialist. Before and 3 months after the consultation, assessments were done to evaluate treatment (use of assistive devices, acetaminophen), health-related quality of life (physical component summary [PCS] score of Short-Form 36), and hand pain/function (Australian/ Canadian Osteoarthritis Hand Index [AUSCAN]). Paired t-tests and McNemar tests were used to analyze differences between baseline and follow-up. Satisfaction was measured after consultation at follow-up using a multidimensional questionnaire comprising 13 items (rated on a four-point scale).
RESULTS
A total of 439 patients were referred, with follow-up data available for 195 patients, comprising 177 (87%) females, and of mean age 59 ± 9.0 years. After consultation, the proportions of patients using assistive devices and/or acetaminophen increased significantly from 30% to 39% and from 35% to 49%, respectively. PCS improved significantly (P = 0.03) whereas AUSCAN hand pain/function showed no significant differences compared with baseline (P values 0.52 and 0.92, respectively). The proportions of patients reporting to be satisfied or fully satisfied ranged from 78% to 99% per item.
CONCLUSION
A single, comprehensive, standardized assessment and education by a clinical nurse specialist improved the physical dimension of health-related quality of life in hand osteoarthritis. Most patients were satisfied with the consultation. Further controlled trials are needed to determine the added value of the clinical nurse specialist in care for hand osteoarthritis.
背景
本研究旨在描述在二级保健中，风湿病医生诊断为原发性手部骨关节炎并转介给临床护理专家的患者，在日常风湿病实践中接受临床护理专家单次 1 小时咨询的有效性。
方法
符合条件的患者为经风湿病医生诊断为原发性手部骨关节炎并被转介给临床护理专家的患者。标准化的 1 小时咨询包括临床护理专家对手部骨关节炎的评估和教育。在咨询前后 3 个月，对治疗情况（辅助设备的使用、对乙酰氨基酚）、健康相关生活质量（SF-36 量表的生理成分综合评分 [PCS]）和手部疼痛/功能（AUSCAN）进行评估。采用配对 t 检验和 McNemar 检验分析基线与随访之间的差异。在随访时使用包含 13 个项目的多维问卷（四点量表评分）评估咨询后的满意度。
结果
共转介了 439 例患者，其中 195 例患者可获得随访数据，包括 177 例（87%）女性，平均年龄 59 ± 9.0 岁。咨询后，使用辅助设备和/或对乙酰氨基酚的患者比例分别从 30%显著增加到 39%和从 35%显著增加到 49%。PCS 显著改善（P = 0.03），而 AUSCAN 手部疼痛/功能与基线相比无显著差异（P 值分别为 0.52 和 0.92）。每个项目报告满意或非常满意的患者比例从 78%到 99%不等。
结论
临床护理专家进行的单次、全面、标准化评估和教育可改善手部骨关节炎患者健康相关生活质量的生理维度。大多数患者对咨询满意。需要进一步的对照试验来确定临床护理专家在手部骨关节炎护理中的附加价值。
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