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Cost-Related Medication Behaviors for Patients With and Without Systemic Autoimmune Rheumatic Diseases. 系统性自身免疫性风湿病患者和非系统性自身免疫性风湿病患者与费用相关的用药行为。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-23 DOI: 10.1002/acr.25442
Jeong Yee, Candace H Feldman, Emily G Oakes, Jack Ellrodt, Hongshu Guan, May Y Choi, Elizabeth W Karlson, Karen H Costenbader

Objective: Medication nonadherence challenges the management of systemic autoimmune rheumatic diseases (SARDs). We investigated cost-related medication behaviors among patients with SARDs, and compared them to those of patients without SARDs, in a large diverse cohort across the United States.

Methods: As part of the All of Us (version 7), a nationwide diverse adult cohort with linked electronic health records begun in 2017, participants completed questionnaires concerning cost-related medication behaviors. Chi-square tests compared responses between patients with SARDs, by disease and medication type, and to those without SARDs. Logistic regression analyses were used to calculate odds ratios (95% confidence intervals [CIs]).

Results: We analyzed data from 3,997 patients with SARDs and 73,990 participants without SARDs. After adjustment, patients with versus without SARDs had 1.56 times increased odds of reporting unaffordability of prescription medicines (95% CI 1.43-1.70), 1.43 times increased odds of cost-related medication nonadherence (95% CI 1.31-1.56), and 1.23 times increased odds of using cost-reducing strategies (95% CI 1.14-1.32). Patients with SARDs who reported unaffordability were 16.5% less likely to receive a disease-modifying drug (95% CI 0.70-0.99) but 18.1% more likely to receive glucocorticoids (95% CI 0.99-1.42). In addition, unaffordability of prescription medicines was likely to have 1.27 times increased odds of one to two emergency room visits per year (95% CI 1.03-1.57) and 1.38-fold increased odds of three or more emergency room visits per year (95% CI 0.96-1.99).

Conclusion: In this large diverse cohort, patients with versus without SARDs had more self-reported cost-related medication behaviors, and those who reported medication unaffordability received fewer disease-modifying drugs and had more emergency room visits.

目的:不遵医嘱用药给系统性自身免疫性风湿病(SARDs)的治疗带来了挑战。我们调查了全美大量不同人群中患有系统性自身免疫性风湿病的患者与费用相关的用药行为,并与未患有系统性自身免疫性风湿病的患者进行了比较:作为 "我们所有人研究(All of Us)计划"(第 7 版)的一部分,参与者填写了与费用相关的用药行为调查问卷。通过卡方检验比较了患有 SARDs 的患者(按疾病和药物类型划分)和未患有 SARDs 的患者之间的回答。逻辑回归分析用于计算几率比(ORs,95% 置信区间):我们分析了 3,997 名 SARDs 患者和 73,990 名无 SARDs 患者的数据。经过调整后,患有 SARDs 的患者与未患有 SARDs 的患者相比,报告无法负担处方药的几率增加了 1.56 倍(95%CI 1.43-1.70),与费用相关的不坚持用药几率增加了 1.43 倍(95%CI 1.31-1.56),使用降低费用策略的几率增加了 1.23 倍(95%CI 1.14-1.32)。报告负担不起的 SARDs 患者接受改变病情药物治疗的可能性降低了 16.5%(95%CI 0.70-0.99),但接受糖皮质激素治疗的可能性增加了 18.1%(95%CI 0.99-1.42)。此外,负担不起处方药可能会使1-2次和≥3次/年急诊就诊的几率分别增加1.27倍(95%CI 1.03-1.57)和1.38倍(95%CI 0.96-1.99):在这一大型多样化队列中,患有 SARDs 的患者与未患有 SARDs 的患者相比,自我报告与费用相关的用药行为更多,那些报告用药负担不起的患者使用的疾病调整药物更少,急诊就诊次数更多。
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引用次数: 0
Rheum for Improvement? Delayed Diagnosis of Juvenile Idiopathic Arthritis: A Narrative Review. 改善风湿病?青少年特发性关节炎的延迟诊断:叙述性综述。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-22 DOI: 10.1002/acr.25438
Anna Costello, Irit Rasooly, Pamela Weiss

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood and a disease for which we have safe and effective therapies. Early diagnosis of JIA enables timely initiation of therapy and improves long-term disease outcomes. However, many patients with JIA experience prolonged diagnostic delays and have a turbulent course to diagnosis. In this narrative review, we explore the importance of early diagnosis in JIA, what is known about time to diagnosis and diagnostic trajectory, and factors that contribute to delayed diagnosis. We also discuss next steps to improve time to diagnosis for these vulnerable patients.

幼年特发性关节炎是儿童时期最常见的风湿性疾病,我们已经有了安全有效的治疗方法。早期诊断 JIA 可以及时开始治疗,并改善疾病的长期预后。然而,许多 JIA 患者的诊断被长期延误,而且诊断过程一波三折。在这篇叙述性综述中,我们探讨了早期诊断在 JIA 中的重要性、对诊断时间和诊断轨迹的了解以及导致诊断延误的因素。我们还讨论了改善这些易感患者诊断时间的下一步措施。
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引用次数: 0
Preferences for Tapering Biologic Disease-Modifying Antirheumatic Drugs Among People With Rheumatoid Arthritis: A Discrete Choice Experiment. 类风湿关节炎患者对减量使用生物制剂改变病情抗风湿药的偏好--离散选择实验。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-22 DOI: 10.1002/acr.25437
Suz Jack Chan, Lisa K Stamp, Gareth J Treharne, Janet M Y Cheung, Nicola Dalbeth, Rebecca Grainger, Simon Stebbings, Carlo A Marra

Objective: Little is known about the preferences of people with rheumatoid arthritis (RA) regarding tapering of biologic disease-modifying antirheumatic drugs (bDMARDs). The aim of this study was to assess the preferences of people with RA in relation to potential treatment-related benefits and risks of bDMARD tapering and the health care service-related attributes that affect tapering.

Methods: Participants with RA who had experience taking a bDMARD completed an online discrete choice experiment. Participants were asked their preferences when given three hypothetical treatment scenarios in which varying the frequency of treatment might alter their chance of adverse effects, of regaining disease control, and of other health care service-related effects. Preference weights were estimated using a multinomial logit model.

Results: There were 142 complete responses. Reduced dosing frequency of bDMARD treatment had the largest impact on preference (mean 1.0, 95% confidence interval [CI] 0.8-1.2), followed by chance of disease flare (mean 0.7, 95% CI 0.6-0.9). Participants were willing to accept an increased risk of flare between 10.6% (95% CI 3.2-17.9) and 60.6% (95% CI 48.1-72.9) in exchange for benefits associated with tapering bDMARDs. Participants with better quality of life were more likely to choose to remain on current treatment. The predicted uptake of bDMARD tapering was high among people with RA, suggesting bDMARD tapering was a favored option.

Conclusion: For individuals with RA, making decisions about tapering bDMARDs involves considering several factors, with the most important determinants identified as dosing frequency and the risk of disease flare. Understanding patient perspectives of bDMARD tapering may enable physicians to make patient-focused shared health care decisions.

目的:人们对类风湿性关节炎(RA)患者减量使用生物制剂改善病情抗风湿药(bDMARDs)的偏好知之甚少。本研究的目的是评估类风湿关节炎患者对生物缓解抗风湿药减量的潜在治疗相关益处和风险的偏好,以及影响减量的医疗服务相关属性:方法:曾服用过 bDMARD 的 RA 患者完成了一项在线离散选择实验。实验询问了参与者在三种假设的治疗情景下的偏好,在这些情景下,改变治疗频率可能会改变他们出现不良反应的几率、重新获得疾病控制的几率以及其他医疗服务相关影响的几率。偏好权重采用多项式对数模型进行估算:共有 142 例完全应答。减少 bDMARDs 治疗的用药频率对偏好的影响最大(平均值:1.0,95%CI 0.8-1.2),其次是疾病复发的几率(平均值:0.7,95%CI 0.6-0.9)。参试者愿意接受疾病复发风险增加10.6%(95%CI 3.2-17.9)到60.6%(95%CI 48.1-72.9)之间,以换取减量服用bDMARDs带来的益处。生活质量较高的参与者更有可能选择继续接受目前的治疗。在RA患者中,bDMARD减量治疗的预测接受率很高,这表明bDMARD减量治疗是一种受欢迎的选择:结论:对于RA患者来说,决定是否减量使用bDMARDs需要考虑多个因素,其中最重要的决定因素是用药频率和疾病复发的风险。了解患者对bDMARD减量的看法可帮助医生做出以患者为中心的共同医疗决策。
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引用次数: 0
Exploring Pain Adaptation in Youth With Juvenile Idiopathic Arthritis: Identifying Youth and Parent Resilience Resources and Mechanisms. 探索青少年特发性关节炎患者对疼痛的适应:确定青少年和家长的适应资源和机制。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-22 DOI: 10.1002/acr.25439
Yvonne N Brandelli, Sean P Mackinnon, Christine T Chambers, Jennifer A Parker, Adam M Huber, Jennifer N Stinson, Shannon A Johnson, Jennifer P Wilson

Objective: Although juvenile idiopathic arthritis (JIA) is often associated with pain, this experience does not necessitate negative outcomes (eg, depression, functional impairment). Little research has explored youth and parent resilience resources (ie, stable traits) and mechanisms (ie, dynamic processes) in this context, and studies have focused on their contributions independently rather than collectively. This study, informed by the Ecological Resilience-Risk Model in Pediatric Chronic Pain, sought to (1) explore the relationships among youth and parent resilience resources and mechanisms and (2) identify the relative importance (RI; ie, independent contributions when entered simultaneously) of evidence-based youth and parent resources and mechanisms in contributing to youth-reported recovery, sustainability, and growth outcomes.

Methods: Youth (13-18 years) with JIA and their parents (156 dyads) completed a battery of online questionnaires assessing resilience resources (optimism, resilience), mechanisms (psychological flexibility, pain acceptance, self-efficacy), recovery and sustainability (pain intensity, functional disability, health-related quality of life), and growth (benefit finding) outcomes.

Results: Analyses demonstrated significant positive correlations across within-person resources and mechanisms and weaker correlations across within-dyad resources and mechanisms. Although the RI of predictors varied by outcome, youth pain acceptance was the most robust predictor across models (RI = 0.03-0.15). Some predictors (eg, parent psychological flexibility and pain acceptance) were generally categorized as "Not Important," whereas others (eg, youth resilience) had "Inconclusive" results, suggesting construct overlap.

Conclusion: Although additional research is needed to further understand resilience, results highlight the importance of fostering pain acceptance in youth and incorporating parents in psychosocial interventions to optimize living with JIA.

目的:尽管幼年特发性关节炎(JIA)通常与疼痛有关,但这种经历并不必然带来负面结果(如抑郁、功能障碍)。在这种情况下,很少有研究探讨青少年和家长的抗逆力资源(即稳定特质)和机制(即动态过程),而且研究都集中在他们的独立贡献而非集体贡献上。本研究以 "小儿慢性疼痛生态复原力-风险模型 "为基础,旨在1)探索青少年和家长的抗逆力资源和机制之间的关系;2)确定以证据为基础的青少年和家长资源和机制在促进青少年报告的康复、可持续性和成长结果方面的相对重要性(RI;即同时输入时的独立贡献):方法:患有 JIA 的青少年(13-18 岁)及其父母(156 对)完成了一系列在线问卷,评估复原力资源(乐观、复原力)、机制(心理灵活性、疼痛接受度、自我效能)、康复/可持续性(疼痛强度、功能性残疾、与健康相关的生活质量)和成长(受益发现)结果:分析表明,个人内部资源和机制之间存在明显的正相关,而团队内部资源和机制之间的相关性较弱。虽然不同结果的预测因子的 RI 各不相同,但在各种模型中,青少年对疼痛的接受程度是最可靠的预测因子(RI=.03-.15)。一些预测因子(如父母的心理灵活性和疼痛接受度)通常被归类为 "不重要",而其他预测因子(如青少年的抗挫折能力)则有 "不确定 "的结果,这表明存在结构重叠:结论:虽然还需要更多的研究来进一步了解恢复能力,但研究结果强调了培养青少年对疼痛的接受能力和将父母纳入心理干预的重要性,以优化JIA患者的生活。
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引用次数: 0
Unveiling the Shadow: Unraveling the Cause of Blindness. 揭开阴影:解开失明的原因》。
IF 4.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-19 DOI: 10.1002/acr.25435
Manush Sondhi,Iman Qaiser,Samina Hayat,Sarwat Umer,Kinza Muzaffar
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引用次数: 0
Low socioeconomic status and female sex are associated with worse functional status in axial spondyloarthritis. 低社会经济地位和女性性别与轴性脊柱关节炎患者功能状况的恶化有关。
IF 4.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-18 DOI: 10.1002/acr.25436
Rachael Stovall, Jing Li, Jessica Fitzpatrick, Eric Roberts, Andriko Palmowski, Christine Anastasiou, Zara Izadi, Janna Friedly, Namrata Singh, Lianne S. Gensler, Gabriela Schmajuk, Jinoos Yazdany
We determined whether socioeconomic status (SES) and sex are associated with functional status (FS) in axial spondyloarthritis (axSpA).
我们研究了社会经济地位(SES)和性别是否与轴性脊柱关节炎(axSpA)的功能状态(FS)有关。
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引用次数: 0
Is Collaborative Care Better Care? 协作式护理是否能提供更好的护理?
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-18 DOI: 10.1002/acr.25434
James T Rosenbaum, Nicole Fett, Daniela Ghetie, Julianna Desmarais
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引用次数: 0
Measurable Outcomes of an Ophthalmology and Rheumatology Coordinated Care Clinic 眼科和风湿病科协调护理诊所的可衡量成果
IF 4.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-15 DOI: 10.1002/acr.25433
Catherine Lavallee, Monica Ahrens, Stefanie Davidson, Haseeb Goheer, Allison Shuster, Melissa A. Lerman
Evaluate the impact of an Ophthalmology/Rheumatology multidisciplinary clinic for patients with anterior uveitis by comparing outcomes between those who received traditional care (TC) versus coordinated care (CC).
通过比较接受传统护理(TC)和协调护理(CC)的患者的治疗效果,评估眼科/风湿科多学科诊所对前葡萄膜炎患者的影响。
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引用次数: 0
Impact of sex, serostatus, and smoking on risk for rheumatoid arthritis‐associated interstitial lung disease subtypes 性别、血清状态和吸烟对类风湿关节炎相关间质性肺病亚型风险的影响
IF 4.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-11 DOI: 10.1002/acr.25432
Gregory C McDermott, Keigo Hayashi, Pierre‐Antoine Juge, Ritu Gill, Suzanne Byrne, Staci Gagne, Xiaosong Wang, Misti L Paudel, Matthew Moll, Michael H Cho, Kathleen Vanni, Emily Kowalski, Grace Qian, Katarina Bade, Alene Saavedra, Yumeko Kawano, Michael DiIorio, Taylor Wolfgang, Edy Y Kim, Paul F Dellaripa, Michael E Weinblatt, Nancy Shadick, Tracy J Doyle, Jeffrey A Sparks
ObjectivesRA‐associated interstitial lung disease (RA‐ILD) includes multiple subtypes with varying histopathology, prognosis, and potential treatments. Limited research has investigated risk factors for different RA‐ILD subtypes. Therefore, we examined demographic, serologic, and lifestyle associations with RA‐ILD subtypes.MethodsWe systematically identified RA‐ILD cases and RA‐noILD controls in the Brigham RA Sequential Study and Mass General Brigham Biobank RA cohort. We determined RA‐ILD subtype (usual interstitial pneumonia [UIP], nonspecific interstitial pneumonia [NSIP], and other/indeterminate) through chest high‐resolution computed tomography imaging pattern. We investigated associations between demographic, lifestyle, and serologic factors and major RA‐ILD subtypes using multivariable logistic regression.ResultsAmong 3328 RA patients, we identified 208 RA‐ILD cases and 547 RA‐noILD controls. RA‐UIP was associated with older age (OR 1.03 per year, 95%CI 1.01 to 1.05), male sex (OR 2.15, 95%CI 1.33 to 3.48), and seropositivity (OR 2.08 95%CI 1.24 to 3.48) while RA‐NSIP was significantly associated only with seropositive status (OR 3.21, 95%CI 1.36 to 7.56). Non‐fibrotic ILDs were significantly associated with smoking (OR 2.81, 95%CI 1.52 to 5.21). Having three RA‐ILD risk factors (male, seropositive, smoking) had an OR of 6.89 (96%CI 2.41 to 19.7) for RA‐UIP compared to having no RA‐ILD risk factors.ConclusionsOlder age, seropositivity, and male sex were strongly associated with RA‐UIP while RA‐related autoantibodies were associated with RA‐NSIP. These findings suggest RA‐ILD sex differences may be driven by RA‐UIP and emphasizes the importance of further studies to clarify RA‐ILD heterogeneity and optimize screening and treatment approaches.
目标RA相关性间质性肺病(RA-ILD)包括多种亚型,其组织病理学、预后和潜在治疗方法各不相同。对不同 RA-ILD 亚型风险因素的研究有限。因此,我们研究了人口统计学、血清学和生活方式与 RA-ILD 亚型的关联。方法我们在布里格姆 RA 序列研究(Brigham RA Sequential Study)和麻省总医院布里格姆生物库 RA 队列中系统地识别了 RA-ILD 病例和 RA-noILD 对照。我们通过胸部高分辨率计算机断层扫描成像图确定了 RA-ILD 亚型(寻常间质性肺炎 [UIP]、非特异性间质性肺炎 [NSIP] 和其他/不确定)。结果在 3328 名 RA 患者中,我们发现了 208 例 RA-ILD 病例和 547 例 RA-noILD 对照。RA-UIP 与年龄较大(OR 值为每年 1.03,95%CI 为 1.01 至 1.05)、男性(OR 值为 2.15,95%CI 为 1.33 至 3.48)和血清阳性(OR 值为 2.08,95%CI 为 1.24 至 3.48)有关,而 RA-NSIP 仅与血清阳性状态显著相关(OR 值为 3.21,95%CI 为 1.36 至 7.56)。非纤维化性 ILD 与吸烟密切相关(OR 2.81,95%CI 1.52 至 5.21)。与无 RA-ILD 风险因素相比,具有三个 RA-ILD 风险因素(男性、血清阳性、吸烟)的 RA-UIP OR 为 6.89(96%CI 2.41 至 19.7)。结论年龄较大、血清阳性和男性性别与 RA-UIP 密切相关,而 RA 相关自身抗体与 RA-NSIP 相关。这些研究结果表明,RA-ILD 的性别差异可能是由 RA-UIP 驱动的,并强调了进一步研究以明确 RA-ILD 异质性并优化筛查和治疗方法的重要性。
{"title":"Impact of sex, serostatus, and smoking on risk for rheumatoid arthritis‐associated interstitial lung disease subtypes","authors":"Gregory C McDermott, Keigo Hayashi, Pierre‐Antoine Juge, Ritu Gill, Suzanne Byrne, Staci Gagne, Xiaosong Wang, Misti L Paudel, Matthew Moll, Michael H Cho, Kathleen Vanni, Emily Kowalski, Grace Qian, Katarina Bade, Alene Saavedra, Yumeko Kawano, Michael DiIorio, Taylor Wolfgang, Edy Y Kim, Paul F Dellaripa, Michael E Weinblatt, Nancy Shadick, Tracy J Doyle, Jeffrey A Sparks","doi":"10.1002/acr.25432","DOIUrl":"https://doi.org/10.1002/acr.25432","url":null,"abstract":"ObjectivesRA‐associated interstitial lung disease (RA‐ILD) includes multiple subtypes with varying histopathology, prognosis, and potential treatments. Limited research has investigated risk factors for different RA‐ILD subtypes. Therefore, we examined demographic, serologic, and lifestyle associations with RA‐ILD subtypes.MethodsWe systematically identified RA‐ILD cases and RA‐noILD controls in the Brigham RA Sequential Study and Mass General Brigham Biobank RA cohort. We determined RA‐ILD subtype (usual interstitial pneumonia [UIP], nonspecific interstitial pneumonia [NSIP], and other/indeterminate) through chest high‐resolution computed tomography imaging pattern. We investigated associations between demographic, lifestyle, and serologic factors and major RA‐ILD subtypes using multivariable logistic regression.ResultsAmong 3328 RA patients, we identified 208 RA‐ILD cases and 547 RA‐noILD controls. RA‐UIP was associated with older age (OR 1.03 per year, 95%CI 1.01 to 1.05), male sex (OR 2.15, 95%CI 1.33 to 3.48), and seropositivity (OR 2.08 95%CI 1.24 to 3.48) while RA‐NSIP was significantly associated only with seropositive status (OR 3.21, 95%CI 1.36 to 7.56). Non‐fibrotic ILDs were significantly associated with smoking (OR 2.81, 95%CI 1.52 to 5.21). Having three RA‐ILD risk factors (male, seropositive, smoking) had an OR of 6.89 (96%CI 2.41 to 19.7) for RA‐UIP compared to having no RA‐ILD risk factors.ConclusionsOlder age, seropositivity, and male sex were strongly associated with RA‐UIP while RA‐related autoantibodies were associated with RA‐NSIP. These findings suggest RA‐ILD sex differences may be driven by RA‐UIP and emphasizes the importance of further studies to clarify RA‐ILD heterogeneity and optimize screening and treatment approaches.","PeriodicalId":8406,"journal":{"name":"Arthritis Care & Research","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142184398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Using Adaptive Choice-Based Conjoint Approach to Facilitate Shared Decision-Making in Osteoarthritis Management: A Patient Perception Study. 利用基于适应性选择的联合方法促进骨关节炎治疗中的共同决策:患者感知研究》。
IF 3.7 2区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-09-08 DOI: 10.1002/acr.25429
Basem Al-Omari, Joviana Farhat, Mohanad Odeh, Mumtaz Khan, Hristo Grancharov, Zaki Abu Zahr, Sammy Hanna, Abdulla Alrahoomi

Objective: This study examines the application of the adaptive choice-based conjoint (ACBC) method to facilitate the shared decision-making (SDM) process for osteoarthritis (OA) treatment.

Methods: The study recruited adult patients with OA attending the rheumatology/orthopedics clinics in a local urban hospital in Abu Dhabi, United Arab Emirates (UAE). Participants completed a questionnaire regarding who influences their decision in selecting OA medication, followed by an ACBC questionnaire about OA medication preferences and a questionnaire about the potential contribution of ACBC to the SDM process. A univariate analysis was used to investigate the relationships between participant variables and factors that influence their decision-making processes. The chi-squared test, Fisher's exact test, Cramér's V coefficient test, and multivariable logistic regression analysis were used. The primary outcome investigates the contribution of the ACBC method to the SDM process for OA treatment. Secondary outcomes measure the association between patient demographics and variables related to the SDM process and ACBC questionnaire.

Results: Five hundred patients participated in this study, with a response rate of 100%. Most study participants were 60 to 69 years old (34.8%), women (78.8%), and UAE nationals (90.4%). Patients' opinions and online or paper information influencing their decision in selecting OA medication had a statistically significant association with age, gender, education, and employment (P = 0.001, P = 0.039, P = 0.002, and P = 0.001, respectively). Employment status showed the strongest association (φc 0.170) with being independent in making the decision about OA medications, whereas education levels showed the strongest association (φc 0.24) with decisions impacted by online or paper information. The results of the multivariable logistic analysis showed that the only statistically significant variable for online or paper information that influenced the decision in selecting OA medication was education level (P = 0.003). Most participants agreed or strongly agreed that the ACBC predicted their preferences for OA treatment (96.8%) and that the questionnaire may help doctors understand patient preferences (93%), and they recommended the use of the ACBC tool in doctors' clinics to aid the SDM process (92.8%) between patients and their physicians.

Conclusion: An ACBC approach can facilitate doctors' understanding of patient preferences and aid the SDM process. Most patients with OA are independent or influenced by their physician when making decisions about OA medication. Higher education and employment among patients with OA are associated with a better involvement in the SDM process for available treatment.

研究目的本研究探讨了基于适应性选择的联合(ACBC)方法在促进骨关节炎(OA)治疗共同决策(SDM)过程中的应用:研究招募了在阿拉伯联合酋长国(阿联酋)阿布扎比当地一家城市医院风湿病学/矫形外科门诊就诊的成年 OA 患者。参与者填写了一份关于谁会影响其选择 OA 用药决定的问卷,随后填写了一份关于 OA 用药偏好的 ACBC 问卷,以及一份关于 ACBC 对 SDM 过程的潜在贡献的问卷。研究人员采用单变量分析来研究参与者变量与影响其决策过程的因素之间的关系。采用了卡方检验、费雪精确检验、Cramer's V 系数检验和多变量逻辑回归分析。主要结果是调查 ACBC 方法对 OA 治疗 SDM 过程的贡献。次要结果测量患者人口统计学特征与SDM过程相关变量和ACBC问卷之间的关联:500名患者参与了这项研究,应答率(RR)为100%。大多数研究参与者的年龄在 60-69 岁之间(34.8%),女性(78.8%),阿联酋国民(90.4%)。影响患者选择 OA 药物的意见和在线/纸质信息与患者的年龄、性别、教育程度和就业有显著的统计学关联(P=0.001 - 0.039)。就业状况与独立做出 OA 用药决定的相关性最强(φc=0.170),而教育水平与受在线/纸质信息影响的决定的相关性最强(φc=0.24)。多变量逻辑分析的结果表明,教育水平是影响选择 OA 药物的在线/纸质信息的唯一具有统计学意义的变量(p=0.003)。大多数参与者同意或非常同意 ACBC 预测了他们对 OA 治疗的偏好(96.8%),问卷可帮助医生了解患者的偏好(93%),并建议在医生诊所使用 ACBC 工具来帮助患者与医生之间的 SDM 流程(92.8%):ACBC方法有助于医生了解患者的偏好,并帮助SDM过程。大多数 OA 患者在做出有关 OA 药物治疗的决定时是独立的,或者受到医生的影响。OA患者受教育程度越高、就业率越高,就越能更好地参与可选治疗的SDM过程。
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引用次数: 0
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Arthritis Care & Research
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