Martin Richard W, Enck Ryan D, Tellinghuisen Donald J, Eggebeen Aaron T, Birmingham James D, Head Andrew J
Department of Medicine, Rheumatology, Michigan State University, College of Human Medicine Grand Rapids, Grand Rapids, MI, USA (RWM, ATE, JDB, AJH).
Michigan State University College of Human Medicine, Grand Rapids, Grand Rapids, MI, USA (RDE).
Med Decis Making. 2017 Jul;37(5):577-588. doi: 10.1177/0272989X17696995. Epub 2017 Mar 15.
To compare the effects a pharmaceutical industry decision guide and International Patient Decision Aids Standard (IPDAS) compliant patient decision aids (PtDA) on patient medication beliefs and choice to intensify therapy.
Rheumatoid arthritis (RA) patients, who had never taken etanercept (Enbrel), took part in a mail survey. They were presented with a hypothetical decision scenario where they were asked to consider adding etanercept to their current regimen. Each patient was randomized to review 1 of 3 forms of an etanercept-specific decision support: a long PtDA (LONG DA), a short PtDA (SHORT DA), or the manufacturer's Enbrel decision guide (Pharm Booklet).
We had 402 RA patients participate in the study (response rate, 52%). Of the patients randomized to the Pharm Booklet, 30.6% elected to initiate etanercept. Only 14.6% and 14.0% of patients who reviewed the LONG DA or SHORT DA choose to take etanercept (χ2 = 15.7; P < 0.001). Patients who reviewed the LONG DA or SHORT DA had a greater increase in knowledge about etanercept than those who reviewed the Pharm Booklet. There was no difference in decisional conflict among the groups. A logistic regression model explained 44.2% (R = 0.442) of patient choice to intensify therapy by initiating etanercept. The strongest predictor of choice to intensify therapy were beliefs about etanercept's ability to improve symptoms (OR = 2.56, 96%CI [1.71, 3.80]), and its use by others like the respondent (OR = 2.24, 95%CI [1.49, 3.35]). Mediation analysis confirmed the presence of a partial mediating effect of decision support on patients' intent to take etanercept (OR = 0.59, 95%CI [0.39, 0.89]).
Patients supported by the Pharm Booklet were twice as likely to choose to intensify therapy. The Pharm Booklet's effects are partially mediated through persuasive communication techniques that influence patients' beliefs that symptoms will improve, and increase social normative beliefs, rather than by increasing the relevant knowledge, clarifying patient values about positive or negative treatment outcomes, or increasing their self-efficacy.
比较一份制药行业决策指南和符合国际患者决策辅助工具标准（IPDAS）的患者决策辅助工具（PtDA）对患者用药信念及强化治疗选择的影响。
从未使用过依那西普（恩利）的类风湿关节炎（RA）患者参与一项邮寄调查。他们面对一个假设的决策情景，被要求考虑在当前治疗方案中加用依那西普。每位患者被随机分配以查看3种依那西普特定决策支持形式中的1种：一份长篇PtDA（LONG DA）、一份短篇PtDA（SHORT DA）或制造商的恩利决策指南（制药手册）。
402名RA患者参与了本研究（应答率为52%）。在被随机分配到制药手册组的患者中，30.6%选择开始使用依那西普。查看长篇PtDA或短篇PtDA的患者中分别只有14.
