Institute for Regional Health Research, University of Southern Denmark, , Odense Denmark.
Ann Rheum Dis. 2014 Feb;73(2):357-64. doi: 10.1136/annrheumdis-2012-202695. Epub 2013 Feb 5.
To compare patient outcomes of three regimes of follow-up care for rheumatoid arthritis (RA) outpatients with low disease activity.
RA outpatients (n=287) with Disease Activity Score (DAS28-CRP)<3.2 and Health Assessment Questionnaire<2.5 from two Danish rheumatology clinics were randomised to 2-year follow-up by either: (1) planned rheumatologist consultations, (2) shared care without planned consultations or (3) planned nursing consultations. The primary outcome was change in disease activity. DAS28-CRP, Health Assessment Questionnaire, visual analogue scale (VAS)-pain, fatigue, global health, confidence and satisfaction, quality-of-life by the Short Form 12 and self-efficacy measured by the RA Self-Efficacy questionnaire and the Arthritis Self-Efficacy Scale, were recorded annually and safety measures were recorded. x-Rays of hands and feet were taken at baseline and at 2-year follow-up. Mixed effect models were used to explore differences between the three groups over time.
At 2-year follow-up, the group allocated to nursing consultations had lower disease activity than the group that underwent rheumatologist consultations (DAS28-CRP -0.3, p=0.049). The nursing group increased their self-efficacy (Arthritis Self-Efficacy Scale 18.8, p=0.001), confidence (10.7, p=0.001) and satisfaction (10.8, p<0.001) compared with the rheumatologist group. The shared care group reported a transient lower satisfaction compared with the rheumatologist group after 1 year (-8.8, p=0.004). No statistically significant differences were seen in other outcome variables.
It is safe to implement shared care and nursing consultations as alternatives to rheumatologist consultations for RA outpatients with low disease activity without deterioration in disease control. Nursing consultations can enhance patients' self-efficacy, confidence and satisfaction.
比较三种低疾病活动度类风湿关节炎（RA）门诊患者随访方案的患者结局。
从丹麦两家风湿病诊所招募了疾病活动评分（DAS28-CRP）<3.2 和健康评估问卷（HAQ）<2.5 的 287 名 RA 门诊患者，将其随机分为 2 年随访期：（1）计划由风湿病医生进行会诊；（2）不计划会诊的共同护理；（3）计划由护士进行会诊。主要结局是疾病活动的变化。每年记录 DAS28-CRP、HAQ、视觉模拟量表（VAS）-疼痛、疲劳、总体健康、信心和满意度、由 12 项简短健康调查问卷（SF-12）测量的生活质量以及由 RA 自我效能问卷和关节炎自我效能量表测量的自我效能，同时记录安全性措施。在基线和 2 年随访时拍摄手部和足部的 X 光片。采用混合效应模型探讨三组之间随时间的差异。
在 2 年随访时，接受护士会诊的组比接受风湿病医生会诊的组疾病活动度更低（DAS28-CRP 低 0.3，p=0.049）。与风湿病医生组相比，护士组的自我效能（关节炎自我效能量表 18.8，p=0.001）、信心（10.7，p=0.001）和满意度（10.8，p<0.001）均有所提高。与风湿病医生组相比，共同护理组在 1 年后的满意度短暂下降（-8.8，p=0.004）。其他结局变量无统计学差异。
对于低疾病活动度的 RA 门诊患者，实施共同护理和护士会诊替代风湿病医生会诊是安全的，不会导致疾病控制恶化。护士会诊可以提高患者的自我效能、信心和满意度。
