风湿科医生和类风湿关节炎患者门诊就诊期望对比研究  

Comparative study on the expectations of both rheumatologists and patients with rheumatoid arthritis in rheumatology clinic visits

作　　者：张晓英[1] 古洁若[2] 马丽[3] 魏华[4] 李小峰[1] 赵向聪[1] 王彩虹[1] 曹双燕[2] 李桂叶[3] 温鸿雁[1] 

机构地区：[1] 山西医科大学第二医院风湿免疫科,太原030001 [2] 中山大学附属第三医院风湿免疫科 [3] 中日友好医院风湿免疫科 [4] 江苏省苏北人民医院风湿免疫科

出　　处：《中华风湿病学杂志》2014年第7期477-481,共5页Chinese Journal of Rheumatology

基　　金：山西省国际科技合作计划（2012081048）

摘　　要：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.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＆#39; 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＆#39; 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

关 键 词：关节炎 类风湿 门诊医疗 药物疗法 患者教育 

分 类 号：R593.22[医药卫生—内科学]