Kugasia A, Sehgal N, Dollear M, Sequeira W, Block J A, Jolly M
1 Rush University Medical Center, Chicago, USA.
2 Indiana University, Bloomington, USA.
Lupus. 2017 Dec;26(14):1556-1561. doi: 10.1177/0961203317716788. Epub 2017 Jun 28.
Background/purpose To plan a quality improvement project, we need to understand the practice patterns of physicians. We undertook an online survey of systemic lupus erythematosus (SLE) patients and physicians providing care to SLE patients to determine the patterns of medical care provided to SLE patients. Materials and methods Two self-report surveys were developed. A 12-item survey for the patients and a 13-item survey for physicians enquired about longitudinal care for SLE. Surveys were administered online to physicians providing care to SLE patients, and to patients who self-identified as having SLE, through the Lupus Society of Illinois. Patient and physician data were analyzed for physician practice patterns for SLE care, using chi square tests and t tests. A P value of 0.05 or less was considered significant on two-tailed tests. Results A total of 283 patients completed the survey. Mean (SD) age and disease duration of patients were 45.9 (13.2) and 12.7 (9.7) years. Half of the participants were being seen at 3-4-month intervals. More than 70% of patients reported being tested for antinuclear antibody (ANA), and 20-30% anti-ENA antibody and Sjögren's (SSA/SSB) antibodies, respectively, at each follow-up visit. Eighty-six rheumatologists completed the surveys. Mean (SD) age was 55 (12) years and 56% were men. More than half (54%) provided care only in a private practice setting. More than 80% of physicians reported seeing their SLE patients at 3-4-month interval. Only 2% reported performing ANA tests at each visit, while 4-5% performed anti-ENA and anti-SSA/SSB antibody tests at each visit for their SLE patients. More than 75% of physicians in private practice also ordered sedimentation rate at each visit for their SLE patients. Conclusions Unnecessary laboratory investigations may be being ordered routinely for patients at every visit. These results indicate a need for physician education on indications and utility of some of the laboratory tests such as ANA.
背景/目的 为了规划一个质量改进项目，我们需要了解医生的执业模式。我们对系统性红斑狼疮（SLE）患者以及为SLE患者提供护理的医生进行了一项在线调查，以确定为SLE患者提供的医疗护理模式。
材料与方法 开发了两项自我报告调查问卷。一项针对患者的12项调查问卷和一项针对医生的13项调查问卷，询问了SLE的纵向护理情况。通过伊利诺伊州狼疮协会，在线向为SLE患者提供护理的医生以及自我认定患有SLE的患者发放调查问卷。使用卡方检验和t检验对患者和医生的数据进行分析，以了解SLE护理的医生执业模式。在双侧检验中，P值小于或等于0.05被认为具有统计学意义。
结果 共有283名患者完成了调查。患者的平均（标准差）年龄和病程分别为45.9（13.2）岁和（9.7）12.7岁。一半的参与者就诊间隔为3至4个月。超过70%的患者报告每次随访时都进行了抗核抗体（ANA）检测，每次随访时分别有20%至30%的患者检测了抗可提取核抗原（ENA）抗体和干燥综合征（SSA/SSB）抗体。86名风湿病学家完成了调查。平均（标准差）年龄为55（12）岁，56%为男性。超过一半（54%）的医生仅在私人诊所提供护理。超过80%的医生报告每3至4个月看一次他们的SLE患者。只有2%的医生报告每次就诊时都进行ANA检测，而4%至5%的医生每次就诊时为他们的SLE患者进行抗ENA和抗SSA/SSB抗体检测。超过75%的私人执业医生每次就诊时也为他们的SLE患者开具血沉检测。
结论 可能每次就诊时都在常规为患者进行不必要的实验室检查。这些结果表明需要对医生进行关于某些实验室检查（如ANA）的适应症和用途的教育。
