Chow Shirley L, Carter Thorne J, Bell Mary J, Ferrari Robert, Bagheri Zarnaz, Boyd Tristan, Colwill Ann Marie, Jung Michelle, Frackowiak Damian, Hazlewood Glen S, Kuriya Bindee, Tugwell Peter
From the Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket; Division of Rheumatology, Department of Medicine, Western University, London; Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, Ontario; Department of Medicine and Department of Rheumatic Diseases, University of Alberta, Edmonton; Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.S.L. Chow, MD; M.J. Bell, MD; Z. Bagheri, MD; D. Frackowiak, MD; B. Kuriya, MD, Division of Rheumatology, Department of Medicine, University of Toronto; J.C. Thorne, MD, Southlake Regional Health Centre; R. Ferrari, MD, Department of Medicine and Department of Rheumatic Diseases, University of Alberta; T. Boyd, MD; M. Jung, MD, Division of Rheumatology, Department of Medicine, Western University; A.M. Colwill, MD, Division of Rheumatology, Department of Medicine, University of British Columbia; G.S. Hazlewood, MD, Division of Rheumatology, Department of Medicine, University of Calgary; P. Tugwell, MD, Division of Rheumatology, Department of Medicine, University of Ottawa.
J Rheumatol. 2015 Apr;42(4):682-9. doi: 10.3899/jrheum.141140. Epub 2015 Feb 1.
To develop a list of 5 tests or treatments used in rheumatology that have evidence indicating that they may be unnecessary and thus should be reevaluated by rheumatology healthcare providers and patients.
Using the Delphi method, a committee of 16 rheumatologists from across Canada and an allied health professional generated a list of tests, procedures, or treatments in rheumatology that may be unnecessary, nonspecific, or insensitive. Items with high content agreement and perceived relevance advanced to a survey of Canadian Rheumatology Association (CRA) members. CRA members ranked these top items based on content agreement, effect, and item ranking. A methodology subcommittee discussed the items in light of their relevance to rheumatology, potential effect on patients, and the member survey results. Five candidate items selected were then subjected to a literature review. A group of patient collaborators with rheumatic diseases also reviewed these items.
Sixty-four unique items were proposed and after 3 Delphi rounds, this list was narrowed down to 13 items. In the member-wide survey, 172 rheumatologists responded (36% of those contacted). The respondent characteristics were similar to the membership at large in terms of sex and geographical distribution. Five topics (antinuclear antibodies testing, HLA-B27 testing, bone density testing, bone scans, and bisphosphonate use) with high ratings on agreement and effect were chosen for literature review.
The list of 5 items has identified starting points to promote discussion about practices that should be questioned to assist rheumatology healthcare providers in delivering high-quality care.
制定一份风湿病学中使用的5项检查或治疗清单，这些检查或治疗有证据表明可能不必要，因此风湿病医疗服务提供者和患者应重新评估。
采用德尔菲法，由来自加拿大各地的16名风湿病学家和一名专职医疗专业人员组成的委员会列出了风湿病学中可能不必要、非特异性或不敏感的检查、程序或治疗清单。内容一致性高且被认为相关的项目进入对加拿大风湿病协会（CRA）成员的调查。CRA成员根据内容一致性、效果和项目排名对这些顶级项目进行排名。一个方法学小组委员会根据这些项目与风湿病学的相关性、对患者的潜在影响以及成员调查结果对其进行了讨论。然后，对选定的5个候选项目进行了文献综述。一组患有风湿性疾病的患者合作者也对这些项目进行了审查。
共提出64个独特项目，经过三轮德尔菲法后，该清单缩小至13个项目。在全成员调查中，172名风湿病学家做出了回应（占被联系者的36%）。在性别和地理分布方面，受访者特征与全体成员相似。选择了在一致性和效果方面评分较高的五个主题（抗核抗体检测、HLA - B27检测、骨密度检测、骨扫描和双膦酸盐的使用）进行文献综述。
这5项项目清单确定了一些起点，以促进对一些做法的讨论，这些做法应受到质疑，以帮助风湿病医疗服务提供者提供高质量的医疗服务。
