Briggs Andrew M, Jordan Joanne E, Ackerman Ilana N, Van Doornum Sharon
School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia Move: Muscle, Bone and Joint Health, Melbourne, Victoria, Australia.
HealthSense (Aust) Pty Ltd, Melbourne, Victoria, Australia.
BMJ Open. 2016 Sep 15;6(9):e012139. doi: 10.1136/bmjopen-2016-012139.
Recognising the need for a best-practice and consistent approach in providing care to women with rheumatoid arthritis (RA) in relation to (1) general health, (2) contraception, (3) conception and pregnancy, (4) breast feeding and (5) early parenting, we sought to achieve cross-discipline, clinical consensus on key messages and clinical practice behaviours in these 5 areas.
3-round eDelphi study. In round 1, panellists provided free-text responses to open-ended questions about care for women with RA across the 5 areas. Subsequently, panellists refined and scored the synthesised responses, presented as metathemes, themes and detailed elements. Where ≥5% of panellists did not support a theme in a given round, it was removed.
Panel of practicing Australian rheumatologists (n=22), obstetricians/obstetric medicine physicians (n=9) and pharmacists (n=5).
34 (94.4%) panellists participated in all 3 rounds. The panel supported 18 themes across the 5 areas (support/strongly support: 88.2-100%) underpinned by 5 metathemes. Metathemes focused on coordination in information delivery, the mode and timing of information delivery, evidence underpinning information, engagement of the right health professionals at the right time and a non-judgemental approach to infant feeding. Themes included practices for primary prevention of chronic disease and their sequelae, the importance of contraception and planning pregnancy and breast feeding, close monitoring of medications, supporting mental well-being, managing disease activity and providing practical support for early parenting.
A cross-disciplinary clinical panel highly supported key information and clinical practices in the care for women with RA across the continuum of contraception to early parenting within a whole-person, chronic disease management approach.
认识到在为类风湿关节炎（RA）女性提供护理时，在（1）一般健康、（2）避孕、（3）受孕与妊娠、（4）母乳喂养和（5）早期育儿方面需要采用最佳实践和一致的方法，我们试图在这五个领域的关键信息和临床实践行为上达成跨学科的临床共识。
三轮电子德尔菲研究。在第一轮中，小组成员对关于RA女性在这五个领域护理的开放式问题提供自由文本回复。随后，小组成员对综合回复进行完善和评分，这些回复以元主题、主题和详细要素的形式呈现。如果在某一轮中≥5%的小组成员不支持某个主题，则将其删除。
由澳大利亚执业风湿病学家（n = 22）、产科医生/产科医学医生（n = 9）和药剂师（n = 5）组成的小组。
34名（94.4%）小组成员参与了所有三轮研究。该小组在五个领域支持18个主题（支持/强烈支持：88.2 - 100%），这些主题由五个元主题支撑。元主题聚焦于信息传递的协调、信息传递的方式和时机、信息的证据基础、在正确时间让合适的健康专业人员参与以及对婴儿喂养采取无偏见的方法。主题包括慢性病及其后遗症的一级预防措施、避孕和计划妊娠及母乳喂养的重要性、密切监测药物、支持心理健康、控制疾病活动以及为早期育儿提供实际支持。
一个跨学科临床小组高度支持在以全人、慢性病管理方法从避孕到早期育儿的连续过程中，对RA女性护理的关键信息和临床实践。
