Gudu Tania, Jadon Deepak R
Department of Rheumatology, Cambridge University Hospitals NHSFT, Cambridge, UK.
Rheumatology Research Unit, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.
Ther Adv Musculoskelet Dis. 2020 Dec 10;12:1759720X20975888. doi: 10.1177/1759720X20975888. eCollection 2020.
Multidisciplinary (MD) care is essential in the management of patients with spondyloarthritis (SpA) and is one of the main pillars of disease management and patient care. However, evidence supporting the effectiveness and benefits of this strategy in SpA is scarce. In this review we discuss the three types of MD care models: (i) combined clinics (MD units), including 'face to face', 'parallel' and 'circuit approach' clinics; (ii) MD team meetings; (iii) group consultations. The most frequently used model in SpA studies has been the 'parallel' combined clinic and usually encompasses a rheumatologist and another specialist, most commonly a dermatologist or a gastroenterologist, that work in tandem according to predefined referral criteria and treatment algorithms. MD working seems to improve the care of patients with SpA by a better identification and diagnosis of the disease, an earlier and more comprehensive treatment approach, and better outcomes for patients in terms of disease activity, physical function, quality of life and patient satisfaction. Nevertheless, challenges remain. Data on effectiveness and feasibility are scarce and are mostly derived from studies with design issues and often without a unidisciplinary care comparator arm. Although patient centricity is one of the core values of patient care and MD setting in SpA, the patient often does not play an active role in most of the MD settings studied or in common clinical practice. Further efforts should be made so that MD care reflects patients' expectations and needs. Overcoming these limits will help to implement successfully SpA MD care in daily clinical practice and subsequently to achieve a higher quality of care for our patients.
多学科（MD）护理在脊柱关节炎（SpA）患者的管理中至关重要，是疾病管理和患者护理的主要支柱之一。然而，支持该策略在SpA中有效性和益处的证据很少。在本综述中，我们讨论了三种多学科护理模式：（i）联合诊所（MD单元），包括“面对面”、“平行”和“巡回式”诊所；（ii）多学科团队会议；（iii）小组咨询。SpA研究中最常用的模式是“平行”联合诊所，通常包括一名风湿病学家和另一名专科医生，最常见的是皮肤科医生或胃肠病学家，他们根据预先确定的转诊标准和治疗算法协同工作。多学科协作似乎通过更好地识别和诊断疾病、更早更全面的治疗方法以及在疾病活动、身体功能、生活质量和患者满意度方面为患者带来更好的结果，从而改善SpA患者的护理。然而，挑战仍然存在。关于有效性和可行性的数据很少，且大多来自存在设计问题的研究，并且往往没有单学科护理对照臂。尽管以患者为中心是SpA患者护理和多学科环境的核心价值观之一，但在所研究的大多数多学科环境或普通临床实践中，患者通常并未发挥积极作用。应进一步努力使多学科护理反映患者的期望和需求。克服这些限制将有助于在日常临床实践中成功实施SpA多学科护理，并进而为我们的患者实现更高质量的护理。
