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疑似中轴型脊柱关节炎患者的预评估:学生主导的临床诊疗与远程医疗相结合:一项定性研究。

Pre-assessment of patients with suspected axial spondyloarthritis combining student-led clinics and telemedicine: a qualitative study.

机构信息

Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf Bei Berlin, Germany.

Department of Internal Medicine 3, Rheumatology and Immunology Friedrich, Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.

出版信息

Rheumatol Int. 2024 Apr;44(4):663-673. doi: 10.1007/s00296-023-05522-z. Epub 2024 Jan 30.

Abstract

OBJECTIVE

Patients referred to rheumatologists are currently facing months of inefficient waiting time due to the increasing demand and rising workforce shortage. We piloted a pre-assessment of patients with suspected axial spondyloarthritis (axSpA) combining student-led clinics and telemedicine (symptom assessment, symptom monitoring and at-home capillary self-sampling) to improve access to rheumatology care. The aim of this study was to explore (1) current challenges accessing axSpA care and (2) patients' first-hand experiences.

METHODS

Embedded within a clinical trial, this study was based on qualitative interviews with patients with suspected axSpA (n = 20). Data was analysed via qualitative content analysis.

RESULTS

Student-led clinics were perceived as high-quality care, comparable to conventional rheumatologist-led visits. Patients expressed that their interactions with the students instilled a sense of trust. History-taking and examinations were perceived as comprehensive and meticulous. Telehealth tools were seen as empowering, offering immediate and continuous access to symptom assessment at home. Patients reported a lack of specificity of the electronic questionnaires, impeding accurate responses. Patients requested a comments area to supplement questionnaire responses. Some patients reported receiving help to complete the blood collection.

CONCLUSION

Patients' access to rheumatology care is becoming increasingly burdensome. Pre-assessment including student-led clinics and telemedicine was highly accepted by patients. Patient interviews provided valuable in-depth feedback to improve the piloted patient pathway.

摘要

目的

由于需求增加和劳动力短缺,转诊给风湿病医生的患者目前面临数月低效的等待时间。我们试点了一种对疑似强直性脊柱炎(axSpA)患者的预评估,结合学生主导的诊所和远程医疗(症状评估、症状监测和家庭毛细血管自我采样),以改善风湿病护理的可及性。本研究的目的是探讨(1)获得 axSpA 护理的当前挑战,(2)患者的第一手体验。

方法

本研究嵌入在一项临床试验中,基于对 20 名疑似 axSpA 患者的定性访谈。通过定性内容分析对数据进行分析。

结果

学生主导的诊所被认为是高质量的护理,与传统的风湿病医生主导的就诊相当。患者表示,他们与学生的互动增强了信任感。病史采集和检查被认为是全面和细致的。远程医疗工具被视为赋予权力的工具,可在家中提供即时和持续的症状评估。患者报告电子问卷缺乏特异性,阻碍了准确的回答。患者要求有评论区来补充问卷回答。一些患者报告说,他们在完成血液采集方面得到了帮助。

结论

患者获得风湿病护理的途径变得越来越繁琐。包括学生主导的诊所和远程医疗在内的预评估受到患者的高度认可。患者访谈为改进试点患者路径提供了有价值的深入反馈。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8225/10914903/2a375839eaef/296_2023_5522_Fig1_HTML.jpg

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