Medical Faculty Mannheim, Mannheim Institute of Public Health, Social and Preventive Medicine, University of Heidelberg, Mannheim, Germany.
J Eur Acad Dermatol Venereol. 2013 Jun;27(6):763-70. doi: 10.1111/j.1468-3083.2012.04569.x. Epub 2012 May 28.
Dissatisfaction with treatment is common among those with psoriasis. While incorporating patients' preferences into the process of treatment decision-making may improve satisfaction, this relationship has not been clearly established.
To assess the extent to which matching physicians' treatment recommendations to patients' treatment preferences is associated with improvement in treatment satisfaction in patients with moderate-to-severe psoriasis.
This prospective cohort study design examined change from baseline to 3-month follow-up in four subscales of an established measure of treatment satisfaction. Separate multivariate regression models investigated the association of change in these subscale scores with an index measuring the match between physicians' treatment recommendations and patients' treatment preferences at the initial study visit.
A closer match between physicians' recommendations and patients' preferences was associated with greater improvement in treatment satisfaction over time in each of the four subscales: effectiveness (β = 0.53, P < 0.001), side-effects (β = 0.25, P = 0.009), convenience (β = 0.78, P < 0.001) and global satisfaction (β = 0.49, P < 0.001). Adjusted models explained as much as 76% of the variation in change in treatment satisfaction subscales over 3 months.
Further efforts to incorporate patients' preferences in treatment decision-making appear justified given the strength of independent associations between preference matching and improved treatment satisfaction and the extent to which our models explained variation in this relationship. An approach based on preference matching shows promise for increasing satisfaction in the management of other chronic diseases.
银屑病患者普遍对治疗不满意。虽然将患者的偏好纳入治疗决策过程可能会提高满意度，但这种关系尚未得到明确确立。
评估将医生的治疗建议与患者的治疗偏好相匹配在多大程度上与中重度银屑病患者的治疗满意度提高相关。
这项前瞻性队列研究设计考察了在经过 3 个月的随访后，一种已建立的治疗满意度测量量表的四个子量表的基线变化。分别使用多元回归模型调查了在初始研究就诊时衡量医生治疗建议与患者治疗偏好之间匹配程度的指标与这些子量表评分变化之间的关联。
医生的建议与患者的偏好越匹配，在四个子量表中的每个子量表中，治疗满意度随时间的改善越大：疗效（β=0.53，P<0.001）、副作用（β=0.25，P=0.009）、方便性（β=0.78，P<0.001）和整体满意度（β=0.49，P<0.001）。调整后的模型解释了 3 个月内治疗满意度子量表变化的 76%。
鉴于偏好匹配与治疗满意度提高之间存在独立关联的强度，以及我们的模型在多大程度上解释了这种关系的变化，进一步努力将患者的偏好纳入治疗决策中是合理的。基于偏好匹配的方法有望提高其他慢性疾病管理的满意度。
