Are rheumatologists' treatment decisions influenced by patients' age?
Are rheumatologists' treatment decisions influenced by patients' age?
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DOI：
10.1093/rheumatology/kel144
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发表时间：
2006-12-01
期刊：
影响因子：
5.5
通讯作者：
Dhar, R.
中科院分区：
文献类型：
--
作者：
Fraenkel, L.;Rabidou, N.;Dhar, R.
目标.本研究的目的是确定医生的治疗偏好是否受到患者年龄的影响。方法。我们邮寄了一份调查问卷给在美国执业的随机抽样的风湿病学家。该调查包括一个场景，描述了一个假设的类风湿性关节炎（RA）患者，使用羟氯喹、柳氮磺胺吡啶和低剂量泼尼松龙，在随访期间出现活动性疾病。该方案制定了两个版本，除了患者的年龄外，这两个版本是相同的。在阅读场景后，要求受访者对三种选择中的每一种的建议进行评分（在10 cm数字评分量表上）：（i）增加泼尼松龙的剂量，（ii）添加新的疾病缓解抗风湿药物（DMARD）和（iii）转换DMARD。风湿病学家将增加新的DMARD或转换DMARD的评分高于增加泼尼松龙剂量的患者归类为“更喜欢DMARD的积极治疗”，而其他患者则归类为“不喜欢DMARD的积极治疗”。共有480名风湿病学家邮寄了一份问卷，204人回复，回复率为42.5%。总体而言，163名（80%）受访者被归类为更喜欢DMARD的积极治疗。对该调查作出回应的风湿病学家更倾向于对年轻RA患者进行积极的DMARD治疗（87%对71%，P= 0.007）。我们的研究结果表明，风湿病学家的治疗建议可能会受到年龄的影响。未来的教育工作应该提高医生对这种可能的偏见的认识，以确保不同年龄段的平等服务。
Objectives. The objective of this study was to determine whether physicians' treatment preferences are influenced by patients' age.Methods. We mailed a survey to a random sample of rheumatologists practicing in the US. The survey included a scenario describing a hypothetical patient with rheumatoid arthritis (RA) on hydroxychloroquine, sulfasalazine and low-dose prednisolone, who presents with active disease during a follow-up appointment. The scenario was formulated in two versions that were identical except for the age of the patient. After reading the scenario, respondents were asked to rate (on a 10 cm numerical rating scale) their recommendations for each of the three options: (i) increasing the dose of prednisolone, (ii) adding a new disease-modifying anti-rheumatic drug (DMARD) and (iii) switching DMARDs. Rheumatologists who rated either adding a new DMARD or switching DMARDs higher than increasing the dose of prednisolone were classified as 'preferring aggressive treatment with DMARDs', while the others were classified as 'NOT preferring aggressive treatment with DMARDs'.Results. A total of 480 rheumatologists were mailed a questionnaire; 204 responded, giving a response rate of 42.5%. Overall 163 (80%) respondents were classified as preferring aggressive treatment with DMARDs. Rheumatologists responding to this survey were more likely to prefer aggressive DMARD treatment for the young RA patient vs the older RA patient (87 vs 71%, P= 0.007).Conclusions. Our findings suggest that rheumatologists' treatment recommendations may be influenced by age. Future educational efforts should increase physician awareness of this possible bias in order to ensure equal service delivery across ages.