El Masri Hiba, Hollingworth Samantha A, van Driel Mieke, Benham Helen, McGuire Treasure M
School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102 Australia.
Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
BMC Rheumatol. 2020 Jun 16;4:27. doi: 10.1186/s41927-020-00126-7. eCollection 2020.
Disease-modifying antirheumatic drugs (DMARDs) have transformed the treatment of numerous autoimmune and inflammatory diseases but their perceived risk of harm may be a barrier to use.
In a retrospective mixed-methods study, we analysed conventional (c) and biologic (b) DMARDs-related calls and compared them with rest of calls (ROC) from consumers to an Australian national medicine call center operated by clinical pharmacists from September 2002 to June 2010. This includes the period where bDMARDs became available on the Pharmaceutical Benefits Scheme, the government-subsidized prescription medicines formulary. We compared caller and patient demographics, enquiry types and motivation to information-seek for both cDMARDs and bDMARDs with ROC, using a t-test for continuous data and a chi-square test for categorical data. We explored call narratives to identify common themes.
There were 1547 calls involving at least one DMARD. The top three cDMARD enquiry types were side effects (27.2%), interactions (21.9%), and risk versus benefit (11.7%). For bDMARDs, the most common queries involved availability and subsidized access (18%), mechanism and profile (15.8%), and side effects (15.1%). The main consumer motivations to information-seek were largely independent of medicines type and included: inadequate information (44%), wanting a second opinion (23.6%), concern about a worrying symptom (18.8%), conflicting information (6.9%), or information overload (2.3%). Question themes common to conventional and biological DMARDs were caller overemphasis on medication risk and the need for reassurance. Callers seeking information about bDMARDs generally overestimated effectiveness and focused their attention on availability, cost, storage, and medicine handling.
Consumers have considerable uncertainty regarding DMARDs and may overemphasise risk. Patients cautiously assess the benefits and risks of their DMARDs but when new treatments emerge, they tend to overestimate their effectiveness.
改善病情抗风湿药物（DMARDs）已经改变了许多自身免疫性和炎性疾病的治疗方式，但人们认为其存在的潜在危害风险可能会成为使用的障碍。
在一项回顾性混合方法研究中，我们分析了与传统（c）和生物（b）DMARDs相关的来电，并将其与2002年9月至2010年6月期间消费者致电澳大利亚一个由临床药剂师运营的全国性药品呼叫中心的其他来电（ROC）进行比较。这包括生物DMARDs被纳入药品福利计划（政府补贴的处方药目录）的时期。我们使用连续数据的t检验和分类数据的卡方检验，将cDMARDs和bDMARDs的来电者和患者人口统计学特征、咨询类型以及寻求信息的动机与其他来电进行比较。我们探究来电记录以识别共同主题。
共有1547个涉及至少一种DMARDs的来电。传统DMARDs的前三大咨询类型是副作用（27.2%）、相互作用（21.9%）以及风险与获益（11.7%）。对于生物DMARDs，最常见的问题涉及可获得性和补贴获取（18%）、作用机制和概况（15.8%）以及副作用（15.1%）。消费者寻求信息的主要动机在很大程度上与药物类型无关，包括：信息不足（44%）、希望获得第二种意见（23.6%）、对令人担忧的症状感到担忧（18.8%）、信息冲突（6.9%）或信息过载（2.3%）。传统和生物DMARDs共有的问题主题是来电者过度强调用药风险以及需要得到安心保证。寻求生物DMARDs信息的来电者通常高估了其有效性，并将注意力集中在可获得性、成本、储存和药物处理方面。
消费者对DMARDs存在相当大的不确定性，并且可能过度强调风险。患者会谨慎评估其DMARDs的获益和风险，但当出现新的治疗方法时，他们往往会高估其有效性。
