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患者参与类风湿关节炎护理,以改善日常实践中基于疾病活动的管理:一项随机对照试验。

Patient involvement in rheumatoid arthritis care to improve disease activity-based management in daily practice: A randomized controlled trial.

机构信息

Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.

Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.

出版信息

Patient Educ Couns. 2022 May;105(5):1244-1253. doi: 10.1016/j.pec.2021.08.013. Epub 2021 Aug 14.

Abstract

OBJECTIVE

To evaluate the effect of an intervention to improve disease activity-based management of RA in daily clinical practice by addressing patient level barriers.

METHODS

The DAS-pass strategy aims to increase patients' knowledge about DAS28 and to empower patients to be involved in treatment (decisions). It consists of an informational leaflet, a patient held record and guidance by a specialized rheumatology nurse. In a Randomized Controlled Trial, 199 RA patients were randomized 1:1 to intervention or control group. Outcome measures were patient empowerment (EC-17; primary outcome), attitudes towards medication (BMQ), disease activity (DAS28) and knowledge about DAS28.

RESULTS

Our strategy did not affect EC-17, BMQ, or DAS28 use. However it demonstrated a significant improvement of knowledge about DAS28 in the intervention group, compared to the control group. The intervention had an additional effect on patients with low baseline knowledge compared to patients with high baseline knowledge.

CONCLUSION

The DAS-pass strategy educates patients about (the importance of) disease activity-based management, especially patients with low baseline knowledge.

PRACTICE IMPLICATIONS

The strategy supports patient involvement in disease activity-based management of RA and can be helpful to reduce inequalities between patients in the ability to be involved in shared decision making.

摘要

目的

通过解决患者层面的障碍,评估改善 RA 疾病活动为基础的管理的干预措施在日常临床实践中的效果。

方法

DAS-pass 策略旨在提高患者对 DAS28 的认识,并赋予患者参与治疗(决策)的能力。它由一份信息传单、一份患者持有的记录和一名专门的风湿病护士的指导组成。在一项随机对照试验中,199 名 RA 患者被随机分为 1:1 的干预组和对照组。主要结局是患者授权(EC-17)、对药物的态度(BMQ)、疾病活动度(DAS28)和对 DAS28 的了解。

结果

我们的策略并没有影响 EC-17、BMQ 或 DAS28 的使用。然而,与对照组相比,它显示出干预组对 DAS28 的了解有了显著的改善。与基线知识高的患者相比,该干预措施对基线知识低的患者有额外的影响。

结论

DAS-pass 策略使患者了解(疾病活动为基础的管理的)重要性,特别是基线知识低的患者。

实践意义

该策略支持患者参与 RA 的疾病活动为基础的管理,并有助于减少患者在参与共同决策能力方面的不平等。

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