了解患者对类风湿关节炎治疗概念化的异质性:一个集群分析
Betty Hsiao1, Julie S Downs2, Mandy Lanyon2
1Yale University, New Haven, Connecticut, USA betty.hsiao@yale.edu.
BMJ open
|September 4, 2023
概括
患者对类风湿性关节炎 (RA) 治疗的理解有所不同,影响治疗到目标 (TTT) 策略的遵守. 改善沟通和解决决策冲突是提高RA管理中的药物坚持的关键.
科学领域:
- 类风湿病学 类风湿病学
- 患者报告的结果
- 医疗服务研究 医疗服务研究
背景情况:
- 针对类风湿性关节炎 (RA) 管理的治疗到目标 (TTT) 策略的采用仍然不够理想.
- 了解患者对RA治疗的看法对于改善对TTT策略的遵守至关重要.
研究的目的:
- 研究患者如何构想类风湿性关节炎治疗的异质性.
- 确定影响患者遵守TTT治疗RA策略的因素.
主要方法:
- 主要组件分析用于患者评级项目,以确定RA治疗概念化中的关键概念.
- 回归分析确定了超越人口统计学特征预测药物坚持的因素.
- 621名RA患者参与了调查,在5分级别上对56个项目进行了评分.
主要成果:
- 在患者对 RA 治疗的概念化中发现了显著的异质性.
- 出现的四个因素是:获得护理,关于DMARD变化的决策冲突较低,DMARD风险/益处看法有利,以及对疾病活性测试的信心.
- 这些因素解释了13.8%的药物坚持差异,患者和医生的沟通质量是不良坚持的关键预测因素.
结论:
- 患者对 RA 治疗的概念是多样化的,尽管了解 TTT 的好处,但在升级疾病修饰性抗风湿药物 (DMARD) 方面存在挑战.
- 需要量身定制的干预措施来解决患者在DMARD升级中的犹,并改善TTT的吸收.
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