Blake A, Mandy P J, Stew G
Podiatry Department, Great Western Hospitals NHS FT, Salisbury, UK.
Musculoskeletal Care. 2013 Dec;11(4):218-28. doi: 10.1002/msc.1044. Epub 2013 Jan 24.
Despite the level of foot involvement in rheumatoid arthritis (RA), and the literature to support early assessment of foot care needs, local referral of patients to podiatry has been occurring too late to instigate certain preventative interventions. Preliminary fieldwork has highlighted that the primary responsibility for the instigation of this lies with the patient. The present study describes the factors that influence the patient with RA in their decision to self-report foot problems.
A case study research strategy was employed. Nine patients attending the outpatient rheumatology department participated in the study and data were gathered through semi-structured interviews. This information was analysed using a framework approach.
The key themes derived from the data suggested that there are a variety of factors influencing the patient's decision to self-report foot concerns. Some will act to encourage the action and others will act to oppose it. Other factors can influence the decision either way, depending on the individual patient (psychological state, previous experience, body image changes). In addition, age, gender, and cultural and social aspects are also significant.
Due to the multitude of factors influencing the individual's decision to seek help, the patient cannot be given sole responsibility for their foot health if we wish to achieve timely and appropriate podiatry, as recommended in the literature. Responsibility should be three-way; the patient, the members of the rheumatology team and, once in the podiatry service, the podiatrist should maintain this.
尽管类风湿性关节炎(RA)患者足部受累程度较高,且有文献支持对足部护理需求进行早期评估,但将患者转诊至足病科的时间往往过晚,无法实施某些预防性干预措施。初步实地调查表明,启动此项工作的主要责任在于患者。本研究描述了影响类风湿性关节炎患者自我报告足部问题决定的因素。
采用案例研究策略。九名到门诊风湿科就诊的患者参与了研究,并通过半结构化访谈收集数据。使用框架分析法对这些信息进行分析。
从数据中得出的关键主题表明,有多种因素影响患者自我报告足部问题的决定。有些因素会促使患者采取行动,而有些则会起到阻碍作用。其他因素则会根据个体患者的情况(心理状态、既往经历、身体形象变化)对决定产生不同影响。此外,年龄、性别以及文化和社会因素也很重要。
由于有众多因素影响个体寻求帮助的决定,如果我们希望按照文献建议实现及时且恰当的足病治疗,就不能将足部健康的责任完全归咎于患者。责任应该由三方共同承担,即患者、风湿科团队成员,以及一旦进入足病科服务体系,足病医生也应承担起这份责任。