Rheumatoid arthritis patients and rheumatologists approach the decision to escalate care differently: results of a maximum difference scaling experiment.
Rheumatoid arthritis patients and rheumatologists approach the decision to escalate care differently: results of a maximum difference scaling experiment.
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DOI：
10.1002/acr.20551
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发表时间：
2011-10
影响因子：
4.7
通讯作者：
Fraenkel, L.
中科院分区：
文献类型：
--
作者：
van Hulst, L. T. C.;Kievit, W.;van Bommel, R.;van Riel, P. L. C. M.;Fraenkel, L.
根据 ACR 指南，对于 DAS28 评分大于 3.2 定义的活动性类风湿关节炎 (RA) 患者，抗风湿药物常常没有得到适当调整。目的是确定哪些因素对患者和风湿科医生升级护理的决定影响最大。我们对 106 名风湿病学家和 213 名 RA 患者进行了最大差异量表调查。该调查包括与 RA 升级护理决定相关的 58 个因素。参与者回答了 24 项选择任务。在每项任务中，参与者被要求从五个因素中选择最重要的因素。我们使用分层贝叶斯建模来生成每个因素的平均相对重要性得分 (RIS)。对于风湿病学家来说，五个最有影响的因素是：肿胀关节的数量（RIS：5.2；sd：0.4）、DAS28评分（RIS 5.2；sd：0.5）、医生对疾病活动度的总体评估（RIS 5.2；sd：0.6）、去年侵蚀恶化（RIS：5.2；sd：0.6）以及与三个月前相比现在的 RA 疾病活动度（RIS 5.1；标准差：0.6）。对于患者来说，最重要的 5 个因素是：当前的身体机能水平（RIS：4.3；sd：1.1）、改善的动机（RIS：3.5；sd：1.4）、对风湿病专家的信任（RIS：3.5；sd：1.6）、对当前 DMARD 的满意度（RIS：3.4；sd：1.4）和当前疼痛关节的数量（RIS） 3.4；标准差：1.4)。风湿病专家和患者之间影响升级护理决定的因素有所不同。患者和医生之间更好的沟通可以改善患有活动性疾病的 RA 患者的治疗计划。
Anti-rheumatic drugs are frequently not appropriately modified, according to ACR Guidelines, in patients with active rheumatoid arthritis (RA) as defined by a DAS28 score greater than 3.2. The objective was to determine which factors most strongly influence patients’ and rheumatologists’ decisions to escalate care. We administered a Maximum Difference Scaling survey to 106 rheumatologists and 213 RA patients. The survey included 58 factors related to the decision to escalate care in RA. Participants answered 24 choice tasks. In each task, participants were asked to choose the most important factor from a set of five. We used Hierarchical Bayes modeling to generate the mean relative importance score (RIS) for each factor. For rheumatologists, the five most influential factors were: number of swollen joints (RIS: 5.2; sd: 0.4), DAS28 score (RIS 5.2; sd 0.5), physician global assessment of disease activity (RIS 5.2. sd 0.6), worsening erosions over the last year (RIS: 5.2; sd: 0.6) and RA disease activity now compared to three months ago (RIS 5.1; sd: 0.6). For patients, the 5 most important factors were: current level of physical functioning (RIS: 4.3; sd: 1.1), motivation to get better (RIS: 3.5; sd: 1.4), trust in their rheumatologist (RIS: 3.5; sd: 1.6), satisfaction with current DMARDs (RIS: 3.4; sd: 1.4) and current number of painful joints (RIS 3.4; sd: 1.4). Factors influencing the decision to escalate care differ between rheumatologists and patients. Better communication between patients and their physicians may improve treatment planning in RA patients with active disease.
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影响因子：
5.5
作者：
Kiely, Patrick D. W.;Brown, Andrew K.;Conaghan, Philip G.
通讯作者：
Conaghan, Philip G.
影响因子：
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作者：
Goekoop-Ruiterman, YPM;de Vries-Bouwstra, JK;Dijkmans, C
通讯作者：
Dijkmans, C
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1.3
作者：
Chilton, Frances;Collett, Raymond A.
通讯作者：
Collett, Raymond A.
影响因子：
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作者：
Schipper, Lydia G.;van Hulst, Laura T. C.;Fransen, Jaap
通讯作者：
Fransen, Jaap
影响因子：
5.5
作者：
Kennedy, T;McCabe, C;Hull, R
通讯作者：
Hull, R