背景:除了持续关注治疗炎症,炎症性关节炎(IA)患者报告了一系列未满足的需求.许多经历不仅残留症状,还有其他各种身体,心理,和社会影响。因此,本研究旨在为IA患者开发复杂的跨学科护士协调自我管理(INSELMA)干预措施,作为对那些有重大疾病影响的人的普通门诊护理的附加治疗。
方法:本研究遵循了英国医学研究委员会关于开发复杂干预措施的最新框架。该过程包括以下步骤:(1)确定了证据基础;(2)举办了研讨会,涉及38个相关利益相关者(管理者,医师,护士,物理治疗师,职业治疗师,社会工作者,来自医院和市政当局的心理学家,和两个患者研究伙伴),讨论和进一步发展初步想法;(3)确定了相关理论(即,自我效能感,接受和承诺疗法,和健康素养);(4)对干预措施进行建模和改造;(5)结果,描述最终的子宫干预和结果。
结果:INSELMA干预包括初步的生物心理社会评估,这是由风湿病护士执行的。然后,确定参与者希望改进的活动并设定目标。护士将参与者推荐给多学科团队,并在参与者的城市协调他们的支持和相关服务。此外,在干预期间,卫生专业人员有机会举行两次跨学科会议。参与者和卫生专业人员在6个月内努力实现既定目标,最后是状态评估和对进一步需求的讨论。INSELMA干预旨在加强自我管理,减少IA的影响(例如,疼痛,疲劳,睡眠问题,和旷工),提高自我效能感,生活质量,心理健康,工作能力,和身体活动。
结论:INSELMA干预措施的发展涉及两个丹麦风湿病门诊诊所的利益相关者,患者研究伙伴和市政当局。我们相信,我们已经确定了重要的机制,以提高IA患者的自我管理和生活质量,并减少严重受影响者的疾病影响。参与的卫生专业人员已经发展了提供干预措施的能力,并准备在可行性研究中进行测试。
BACKGROUND: Apart from a consistent focus on treating inflammation, patients with inflammatory arthritis (IA) report a range of unmet needs. Many experience not only residual symptoms but also various other physical, psychological, and social effects. Therefore, this study aimed to develop a complex Interdisciplinary Nurse-coordinated self-management (INSELMA) intervention for patients with IA, as an add-on treatment to usual outpatient care for those with substantial disease impact.
METHODS: This study followed the British Medical Research Council\'s updated framework for developing complex interventions. The process encompassed the following steps: (1) The evidence base was identified; (2) workshops were held, involving 38 relevant stakeholders (managers, physicians, nurses, physiotherapists, occupational therapists, social workers, psychologists from hospitals and municipalities, and two patient research partners), to discuss and further develop the preliminary ideas; (3) relevant theories were identified (i.e., self-efficacy, acceptance and commitment therapy, and health literacy); (4) the intervention was modeled and remodeled and (5) the results, describing the final INSELMA intervention and outcomes.
RESULTS: The INSELMA intervention encompasses an initial biopsychosocial assessment, which is performed by a rheumatology nurse. Then, activities that the participant wishes to improve are identified and goals are set. The nurse refers the participant to a multidisciplinary team and coordinates their support and relevant services in the participant\'s municipality. In addition, the health professionals have the opportunity to hold two interdisciplinary conferences during the intervention period. The participant and the health professionals work to achieve the set goals during a 6-month period, which ends with a status assessment and a discussion of further needs. The INSELMA intervention aims to increase self-management, reduce the impact of IA (e.g., pain, fatigue, sleep problems, and absenteeism), and increase self-efficacy, quality of life, mental well-being, work ability, and physical activity.
CONCLUSIONS: The development of the INSELMA intervention involved stakeholders from two Danish rheumatology outpatient clinics, patient research partners and municipalities. We believe that we have identified important mechanisms to increase the self-management and quality of life of people with IA and to decrease the disease impact in those who are substantially affected. The health professionals involved have developed competences in delivering the intervention and it is ready to be tested in a feasibility study.