原发性胆道胆炎中的在患者医疗记录中记录不足
Usha Gungabissoon1, Helen T Smith2, Robyn von Maltzahn2
1GSK, London, UK usha.2.gungabissoon@gsk.com.
BMJ open gastroenterology
|March 27, 2024
概括
初级胆道炎 (PBC) 中的与患者报告相比,在医疗图表中记录不足,影响生活质量. 这突显了医生意识的差距和胆固醇性的潜在治疗不足.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 患者报告的结果
背景情况:
- 胆固醇性显著降低了原发性胆道胆炎 (PBC) 患者的与健康相关的生活质量 (HRQoL).
- 现有的文献表明,患者医疗记录中的记录往往不足.
- 这种差异可能导致医生对的真实患病率和影响缺乏认识.
研究的目的:
- 为了比较医疗记录中的的记录与患有PBC的个体的患者自我报告.
- 调查轻度是否不太可能被记录在医疗记录中.
- 分析与记录与患者报告的有关的临床人口统计特征和HRQoL.
主要方法:
- 一项采用医疗记录数据和来自美国PBC队列的患者报告结果 (PBC-40) 的横截面研究.
- 在医疗记录中被归类为"最近"或"曾经"以及PBC-40问卷中的域得分 (任何或临床显著).
- 患者特征和HRQoL (PBC-40领域) 被与记录和患者报告的之间的组进行了比较.
主要成果:
- 观察到自我报告的的高发病率 (88.9%),与最近的医疗记录文档 (39.1%) 的较低发病率形成对比.
- 53.3%的患者报告了临床显著的,其中只有53.3%的人有最近的医疗记录文件.
- 与没有/轻度患者相比,临床显著的患者在PBC-40领域报告了更差的HRQoL.
结论:
- 与患者自我报告相比,PBC中的 Pruritus 在医疗记录中被大量记录不足.
- 的记录不足导致对其负担的低估,可能导致治疗不足.
- 解决这一文档缺口对于改善PBC患者的患者护理和生活质量至关重要.
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