MDHAQ/RAPID3可以为所有风湿病就诊提供路线图或议程,当整个MDHAQ在所有患者就诊时完成,并在就诊前由医生审查。

Theodore Pincus, Philip T Skummer, Michael T Grisanti, Isabel Castrejón, Yusuf Yazici
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引用次数: 0

摘要

与大多数其他慢性疾病相比,类风湿关节炎(RA)的治疗更多地取决于患者的病史。患者问卷提供了统一的、定量的、程序化的、“科学的”患者病史,对类风湿关节炎的工作残疾和死亡率具有比x光片和实验室检查更有记录的预后意义,能够在临床试验中区分主动治疗和对照治疗,并监测临床护理,其意义与关节计数或实验室检查相当或更重要。因此,风湿病患者的“科学”护理方法包括在与患者交谈之前,在MDHAQ上回顾患者的功能、疼痛、整体状态、疲劳、RAPID3、系统回顾、自我报告关节计数和近期病史。这种做法类似于医生在与患有高血压、糖尿病、艾滋病毒或骨折愈合的患者会面之前检查血压、糖化血红蛋白、病毒载量或x光片,为就诊提供路线图或日程。一些站点在没有MDHAQ的情况下实现了RAPID3,这是不鼓励的做法。MDHAQ只需要患者5到10分钟的时间,只需要一张纸,这是简单的RAPID3所需要的,甚至是对DAS28或CDAI评分的患者总体状态估计。每位患者在每次就诊时完成MDHAQ/RAPID3,并由医生进行检查,有助于患者为就诊做好准备,改善医患沟通,为医生节省时间,并为就诊提供路线图或议程。
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MDHAQ/RAPID3 can provide a roadmap or agenda for all rheumatology visits when the entire MDHAQ is completed at all patient visits and reviewed by the doctor before the encounter.

The management of rheumatoid arthritis (RA) depends more on the patient history than most other chronic diseases. A patient questionnaire provides a uniform, quantitative, protocolized, "scientific" patient history, with documented prognostic significance for work disability and mortality in RA greater than radiographs and laboratory tests and capacity to distinguish active from control treatment in clinical trials and to monitor clinical care with equivalent or greater significance than joint counts or laboratory tests. Therefore, a "scientific" approach to care of a person with a rheumatic disease involves review of patient function, pain, global status, fatigue, RAPID3, review of systems, self-report joint count, and recent medical history on an MDHAQ before conversation with the patient. This practice may be viewed as analogous to a doctor reviewing blood pressure, hemoglobin A1c, viral load, or radiograph before meeting with a patient who has hypertension, diabetes, HIV, or a healing fracture to provide a roadmap or agenda for the visit. Some sites have implemented RAPID3 without the remainder of MDHAQ, a practice that is discouraged. The MDHAQ requires only 5 to 10 minutes of the patient's time and involves a single sheet of paper, which is needed for a simple RAPID3, or even a patient global estimate of status to score a DAS28 or CDAI. Completion of MDHAQ/RAPID3 by each patient at each visit in the infrastructure of care with review by the doctor helps prepare the patient for the visit, improves doctor-patient communication, saves time for the doctor, and provides a roadmap or agenda for the visit.

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