Patient and clinician views on the quality of foot health care for rheumatoid arthritis outpatients: a mixed methods service evaluation.
Patient and clinician views on the quality of foot health care for rheumatoid arthritis outpatients: a mixed methods service evaluation.
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DOI：
10.1186/s13047-015-0133-2
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发表时间：
2016
影响因子：
2.9
通讯作者：
Lempp H
中科院分区：
文献类型：
--
作者：
de Souza S;Williams R;Lempp H
足部通常是类风湿性关节炎（RA）关节受累的第一个部位，如果不加以管理，病情会逐渐恶化，导致永久性残疾，并对患者的生活质量产生负面影响。足科医生是评估、诊断和管理足和踝关节问题的专家，然而，RA门诊患者通常依赖风湿病学临床医生的转诊来获得英国国民健康服务（NHS）的肌肉骨骼足病服务。因此，本评价的目的是确定类风湿关节炎患者的足部健康需求，以及风湿病临床医生是否满足这些需求。采用混合方法：从患者收集定性数据，从临床医生收集定量数据。两个焦点小组进行了9 RA患者从三级风湿病门诊在英国和数据进行了专题分析，告知临床医生调查。来自同一中心的13名风湿病学临床医生完成了在线调查。分析所得数据以产生描述性统计量。患者焦点组数据产生了四个主题：（1）需要足部健康信息，（2）在常规咨询中忽视足部，（3）足部检查的频率和（4）获得足病治疗。调查数据强调，（i）69- 85%的临床医生有时为患者提供足部健康信息，（ii）在47%的常规咨询中检查足部，（iii）54%的临床医生没有常规检查足部，因为它们不包括在28个关节的疾病活动评分（DAS-28）中，（iv）31%的临床医生在诊断为RA时将患者转诊至足病科，（v）0%的临床医生将患者转诊至足病科进行定期复查，（vi）54%的临床医生认为患者会自我报告足部问题，以及（vii）62%的临床医生认为能够胜任足部检查。风湿病临床医生没有完全满足RA患者的足部健康需求。患者想要足部健康信息和方便地获得足病服务。流变学门诊咨询需要有一个比DAS-28更广泛的关注点，并将足部检查作为标准。临床医生需要确保他们有足够的培训，并遵循目前的国家足部健康指南，为他们的RA患者提供最佳的足部保健和结果。本文的在线版本（doi：10.1186/s13047-015-0133-2）包含补充材料，可供授权用户使用。
Feet are often the first site of joint involvement in rheumatoid arthritis (RA) and get progressively worse if unmanaged, leading to permanent disability and negatively impacting patients’ quality of life. Podiatrists are specialists in the assessment, diagnosis and management of foot and ankle problems, however, RA outpatients often rely on referral from rheumatology clinicians to gain access to musculoskeletal podiatry services on the UK National Health Service (NHS). Therefore, the aim of this evaluation was to identify the foot health needs of rheumatoid arthritis patients and if they are being met by rheumatology clinicians. A mixed methods approach was used: collecting qualitative data from patients and quantitative data from clinicians. Two focus groups were conducted with nine RA patients from a tertiary rheumatology outpatient clinic in the UK and the data were thematically analysed to inform a clinician survey. Thirteen rheumatology clinicians, from the same centre, completed the online survey. Resultant data were analysed to produce descriptive statistics. Patient focus group data generated four main themes: (1) need for foot health information, (2) feet ignored during routine consultations, (3) frequency of foot examination and (4) access to podiatry. Survey data highlighted that (i) 69–85 % of clinicians provided patients with foot health information sometimes, (ii) feet were examined in 47 % of routine consultations, (iii) 54 % of clinicians did not examine feet routinely because they are not included in the disease activity score with 28 joints (DAS-28), (iv) 31 % of clinicians referred patients to podiatry upon RA diagnosis, (v) 0 % of clinicians referred patients to podiatry for periodic review, (vi) 54 % of clinicians believed patients will self-report foot problems and (vii) 62 % of clinicians felt competent in foot examination. RA patients’ foot health needs were not being fully met by rheumatology clinicians. Patients want foot health information and easy access to podiatry services. Rheumatology outpatient consultations need to have a wider focus than the DAS-28 and incorporate foot examination as standard. Clinicians need to ensure they have sufficient training and follow current national foot health guidance to provide optimal foot health care and outcomes for their RA patients. The online version of this article (doi:10.1186/s13047-015-0133-2) contains supplementary material, which is available to authorized users.