Fraenkel Liana, Cunningham Meaghan, Peters Ellen
Yale University School of Medicine, New Haven, CT (LF)
VA Connecticut Healthcare System, West Haven, CT (LF)
Med Decis Making. 2015 Jan;35(1):6-11. doi: 10.1177/0272989X14532531. Epub 2014 Apr 23.
Preference for the status quo, or clinical inertia, is a barrier to implementing treat-to-target protocols in patients with chronic diseases such as rheumatoid arthritis (RA). The objectives of this study were to examine the influence of subjective numeracy on RA-patient preference for the status quo and to determine whether age modifies this relationship.
RA patients participated in a single face-to-face interview. Numeracy was measured using the Subjective Numeracy Scale. Treatment preference was measured using Adaptive Conjoint Analysis.
Of 205 eligible subjects, 156 agreed to participate. Higher subjective numeracy was associated with lower preference for the status quo in a regression model including race, employment, and use of biologics (adjusted odds ratio [95% confidence interval] = 0.71 [0.52-0.95], P = 0.02). Higher subjective numeracy was protective against status quo preferences among subjects younger than 65 years (adjusted odds ratio [95% confidence interval] = 0.64 (0.43-0.94), P = 0.02) but not among older subjects.
Subjective numeracy is independently associated with younger, but not older, RA patients' preferences for the status quo. Our results add to the literature demonstrating age and numeracy differences in treatment preferences and medical decision-making processes.
对现状的偏好，即临床惰性，是在类风湿关节炎（RA）等慢性病患者中实施达标治疗方案的一个障碍。本研究的目的是检验主观数字能力对类风湿关节炎患者对现状偏好的影响，并确定年龄是否会改变这种关系。
类风湿关节炎患者参与了一次面对面访谈。使用主观数字能力量表测量数字能力。使用自适应联合分析测量治疗偏好。
在205名符合条件的受试者中，156名同意参与。在一个包括种族、就业情况和生物制剂使用情况的回归模型中，较高的主观数字能力与对现状较低的偏好相关（调整后的优势比[95%置信区间]=0.71[0.52 - 0.95]，P = 0.02）。在65岁以下的受试者中，较高的主观数字能力可防止对现状的偏好（调整后的优势比[95%置信区间]=0.64(0.43 - 0.94)，P = 0.02），但在年龄较大的受试者中并非如此。
主观数字能力与年轻类风湿关节炎患者对现状的偏好独立相关，但与老年患者无关。我们的结果补充了文献，证明了治疗偏好和医疗决策过程中的年龄和数字能力差异。
