Department of Rheumatology and Immunology Nursing, Sichuan Provincial People's Hospital, The University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
Department of Rheumatology and Immunology Nursing, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China.
Medicine (Baltimore). 2023 Oct 27;102(43):e35398. doi: 10.1097/MD.0000000000035398.
The European League Against Rheumatism recommendations for the management of rheumatoid arthritis advised the involvement of clinical nurses for the management of rheumatoid arthritis. However, The European League Against Rheumatism recommendations are difficult to apply to Chinese institutes. In China, the rheumatology nursing service is not widely adopted because the feasibility and quality of rheumatology nursing service have not been confirmed in the Chinese population by the Chinese authorities. The objectives of the study were to compare 2.5 years clinical outcomes of patients of rheumatoid arthritis (6 months history) with disease activity score 28-joint count with C-reactive protein (DAS28-CRP) > 5.1 who received nurse-supported care against those of patients who received rheumatologist-led care. Patients received 30 minutes/day and 6 times/week nurse-supported care (NC cohort, n = 127) or Patients had received 20 minutes session at every 3 months of conventional outpatient-based rheumatologist-led care (n = 131). Both types of care have involved the history of patients, care regarding effects and adverse effects of pharmacological treatments, patients education, overall well-being, everyday life, counseling, clarifications, and rehabilitation. Additionally, there were a cohort in which patients did not receive any nontreatment care (NN cohort, n = 141). All patients have definite depression and anxiety (hospital anxiety and depression scale Chinese version score ≥ 11) before nontreatment interventions. At 2.5 years of treatments with or without nontreatment interventions (EL) DAS28-CRP, depression, and anxiety scores of patients of the NC cohort were decreased as compared to their before any type of nontreatment interventions conditions and those of patients of the RC and NN cohorts at EL (P < .001 for all). At EL numbers of patients with moderate disease activity, (DAS28-CRP score: 3.2-5.1) and borderline depression and anxiety (hospital anxiety and depression scales Chinese version score: 8-10) were greater in the NC cohort than those of the RC and NN cohorts (P < .001 for all). Outpatient care satisfaction scores of patients of the NC cohort were higher than those of the RC [23 (27-17) vs 17 (21-14)] and NN [23 (7-17) vs 15 [18-12]) cohorts (P < .001 for both). Physiological and psychological conditions of patients with rheumatoid arthritis with DAS28-CRP > 5.1 are required to improve. Nurse-supported care is superior nontreatment compared to rheumatologist-led care in rheumatoid arthritis patients with high disease activity (Level of Evidence: IV; Technical Efficacy: Stage 5).
欧洲抗风湿病联盟建议在类风湿关节炎的管理中引入临床护士。然而，欧洲抗风湿病联盟的建议在实际应用上对于中国医疗机构来说有一定难度。在中国，由于中国当局尚未确定风湿病护理服务在中国人中的可行性和质量，因此尚未广泛采用风湿病护理服务。本研究的目的是比较疾病活动评分 28 关节计数与 C 反应蛋白（DAS28-CRP）>5.1 的类风湿关节炎（病史 6 个月）患者接受护士支持护理与接受风湿病医生主导护理的 2.5 年临床结局。患者接受每天 30 分钟，每周 6 次的护士支持护理（NC 组，n=127）或接受每 3 个月进行 20 分钟常规门诊风湿病医生主导护理（RC 组，n=131）。两种类型的护理均包括患者的病史、药物治疗效果和不良反应的护理、患者教育、整体健康状况、日常生活、咨询、澄清和康复。此外，还有一组患者未接受任何非治疗护理（NN 组，n=141）。所有患者在进行非治疗干预之前都有明确的抑郁和焦虑（医院焦虑和抑郁量表中文版评分≥11）。在接受或不接受非治疗干预的 2.5 年治疗后（EL），NC 组患者的 DAS28-CRP、抑郁和焦虑评分均较任何类型的非治疗干预前有所下降，RC 组和 NN 组患者的评分也有所下降（所有 P<.001）。在 EL，NC 组中，中度疾病活动（DAS28-CRP 评分：3.2-5.1）和边界性抑郁和焦虑（医院焦虑和抑郁量表中文版评分：8-10）的患者比例高于 RC 组和 NN 组（所有 P<.001）。NC 组患者的门诊护理满意度评分高于 RC 组[23（27-17）比 17（21-14）]和 NN 组[23（7-17）比 15（18-12）]（均 P<.001）。需要改善 DAS28-CRP>5.1 的类风湿关节炎患者的生理和心理状况。在疾病活动度高的类风湿关节炎患者中，护士支持护理优于风湿病医生主导护理（证据水平：IV；技术功效：第 5 阶段）。
