CAJ | 학술논문

目的对比风湿科医生和RA患者门诊就诊期望的不同,为临床医患双方进一步沟通提供最佳切入点.方法全国共4个中心的170例RA患者和93名风湿科医生参与本研究.研究采取门诊问卷调查的方式.请风湿科医生和RA患者列出在风湿科门诊就诊中最期望解决的3个问题.研究人员为RA患者填写临床相关资料,包括年龄、性别、病程、DAS28.之后将临床期望值分类列出,其中患者所关注的内容有23项,医生所关注的内容有17项.期望值的自由叙述应用KJ方法来分析,将期望值按照出现频率排序,对比医生与患者期望值的不同,并评估患者期望值与年龄、性别、病程和DAS28的关联性.结果 RA患者和医生之间临床期望值具有一致性和不一致性.患者门诊就诊时的前3位期望值依次为疼痛的控制(64.7％,110/170),功能恢复(30.0％,51/170)和药物治疗效果的讨论(30.0％,51/170).医生的前3位期望值依次为疼痛的控制(62.4％,58/93),关于药物不良反应(45.2％,42/93)和疾病活动度的客观评估(38.7％,36/93).患者的期望值在不同性别之间相似,但是在不同年龄、病程和DAS28评分之间有差别.年轻患者(≤40岁)更加关注药物不良反应,而年老患者(≥40岁)更加关注功能恢复;DAS28≥3.2及长病程(＞2年)的患者更关注能够完成日常生活;而DAS28＜3.2的患者更加关注药物不良反应.结论 RA患者和风湿科医生关于门诊就诊期望值在疼痛的控制方面是一致的,并均位于首位.但除此之外,存在一些不一致性.研究结果为临床医患双方有效沟通提供最佳切入点,从而最大程度地提高RA患者门诊诊疗效果.
목적 대비풍습과의생화RA환자문진취진기망적불동,위림상의환쌍방진일보구통제공최가절입점.방법 전국공4개중심적170례RA환자화93명풍습과의생삼여본연구.연구채취문진문권조사적방식.청풍습과의생화RA환자렬출재풍습과문진취진중최기망해결적3개문제.연구인원위RA환자전사림상상관자료,포괄년령、성별、병정、DAS28.지후장림상기망치분류렬출,기중환자소관주적내용유23항,의생소관주적내용유17항.기망치적자유서술응용KJ방법래분석,장기망치안조출현빈솔배서,대비의생여환자기망치적불동,병평고환자기망치여년령、성별、병정화DAS28적관련성.결과 RA환자화의생지간림상기망치구유일치성화불일치성.환자문진취진시적전3위기망치의차위동통적공제(64.7％,110/170),공능회복(30.0％,51/170)화약물치료효과적토론(30.0％,51/170).의생적전3위기망치의차위동통적공제(62.4％,58/93),관우약물불량반응(45.2％,42/93)화질병활동도적객관평고(38.7％,36/93).환자적기망치재불동성별지간상사,단시재불동년령、병정화DAS28평분지간유차별.년경환자(≤40세)경가관주약물불량반응,이년로환자(≥40세)경가관주공능회복;DAS28≥3.2급장병정(＞2년)적환자경관주능구완성일상생활;이DAS28＜3.2적환자경가관주약물불량반응.결론 RA환자화풍습과의생관우문진취진기망치재동통적공제방면시일치적,병균위우수위.단제차지외,존재일사불일치성.연구결과위림상의환쌍방유효구통제공최가절입점,종이최대정도지제고RA환자문진진료효과.
Objective To describe and compare the expectations of patients with rheumatoid arthritis (RA) and their rheumatologists with regard to what is most important to achieve during a rheumatology clinic visit.Methods Subjects were 170 RA patients enrolled in four centers from China and 93 rheumatologists at those centers.The questionnaires were provided at clinics.Patients and their physicians were asked to list their three top priorities for the rheumatology clinic visit.The researchers collected patients' clinical information,including age,gender,reported disease duration and disease activity score 28 (DAS28).We classified clinical expectations into a series of 23 terms for patients and 17 for physicians.Free descriptions of expectations were analyzed using the K J-method.We sorted and reported the expectations in the order of the frequency listed.Next,the differences were compared between patients and physicians,and evaluated relationships between patients' responses and age,gender,disease duration and DAS28.Results We found some agreement and some discordance of clinical expectations between RA patients and physicians.Patients' clinical expectations was focused primarily on control of pain (64.7％,110/170),improvement of function (30.0％,51/170) and discussion of effects of medication (30.0％,51/170).Physicians also included control of pain (62.4％,58/93),but also emphasized inquiry about drug side-effects (45.2％,42/93) and objective assessment of disease activity (38.7％,36/93).We found no differences related to patients' gender,but there were some differences related to age,disease duration and DAS28.The younger patients (age ≤40 years) paid special attention to drug side-effects rather than discussion of effect of medication noted by older patients (age＞40 years).Completion of daily living was listed by patients who had long disease course (≥2 years) and higher disease activity (DAS28 ≥ 3.2),while inquiry about drug side-effects was selected by patients who has lower disease activity (DAS28＜3.2).Conclusion Patients and physicians generally agree that control of pain is the top priority.But in addition,there is some discordance of clinical expectations between RA patients and physicians.Findings from this pilot survey may help physicians and patients communicate effectively,and may lead to improved health outcomes during rheumatology clinic visits.