背景:患有慢性疾病如类风湿性关节炎(RA)需要药物和治疗,以及多学科临床团队的长期随访。患者参与药物治疗方案的共同决策过程是促进药物依从性的重要因素。文献回顾和需求评估表明,基于技术的干预措施可以使患者掌握有关慢性病的知识和能力,以提高他们对药物的依从性。因此,我们开发了一项基于网络的干预措施,使RA患者能够坚持其改善病情的抗风湿药(DMARDs)用药方案.
目的:本研究旨在讨论基于网络的干预设计中的干预映射过程,该过程支持患者对药物依从性的授权,并评估其在RA患者中的可行性。
方法:RA患者基于理论的患者授权药物依从性计划(PE2MAP)建立在Zimmerman心理授权框架上,通过Udemy网站启动的基于网络的程序。PE2MAP是使用6步干预映射过程开发的:(1)需求评估,(2)方案目标,(3)指导干预的概念框架,(4)方案计划,(5)收养,(6)涉及多学科卫生保健专业人员(HCP)和多媒体团队的评估。PE2MAP被设计为一个为期4周的基于网络的干预计划,并附有补充的RA手册。在积极服用DMARD治疗RA的干预组30名参与者中完成了一项可行性随机对照试验,以测试PE2MAP的可接受性和可行性。
结果:30名参与者的平均年龄和病程分别为52.63岁和8.50岁,分别。可行性数据显示,87%(n=26)完成了为期4周的基于网络的PE2MAP干预,57%(n=17)完成了所有100%的内容,27%(n=8)完成了96%到74%的内容,表明干预的总体可行性。作为一个整体,96%(n=24)的参与者发现了有关管理药物副作用的信息,保持健康,管理突发事件,和监测关节肿胀/疼痛/僵硬作为干预的最有用的内容。此外,88%(n=23)和92%(n=24)同意干预措施改善了他们对药物的依从性和副作用的管理,包括与他们的医疗团队沟通的信心,分别。96%(n=25)的中药被发现有用。目标设定被6名(23.1%)参与者评为最不有用的技能。
结论:基于网络的PE2MAP干预被认为是可以接受的,可行,作为一种有效的网络工具,使RA患者能够管理和坚持他们的DMARD药物。需要进一步精心设计的随机对照试验来探索这种干预措施在RA患者管理中的有效性。
BACKGROUND: Living with a chronic illness such as rheumatoid arthritis (RA) requires medications and therapies, as well as long-term follow-up with multidisciplinary clinical teams. Patient involvement in the shared decision-making process on medication regimens is an important element in promoting medication adherence. Literature review and needs assessment showed the viability of technology-based interventions to equip patients with knowledge about chronic illness and competencies to improve their adherence to medications. Thus, a web-based intervention was developed to empower patients living with RA to adhere to their disease-modifying antirheumatic drugs (DMARDs) medication regimen.
OBJECTIVE: This study aims to discuss the intervention mapping process in the design of a web-based intervention that supports patient empowerment to medication adherence and to evaluate its feasibility among patients living with RA.
METHODS: The theory-based Patient Empowerment to Medication Adherence Programme (PE2MAP) for patients with RA was built upon the Zimmerman Psychological Empowerment framework, a web-based program launched through the Udemy website. PE2MAP was developed using a 6-step intervention mapping process: (1) needs assessment, (2) program objectives, (3) conceptual framework to guide the intervention, (4) program plan, (5) adoption, and (6) evaluation involving multidisciplinary health care professionals (HCPs) and a multimedia team. PE2MAP is designed as a 4-week web-based intervention program with a complementary RA handbook. A feasibility randomized controlled trial was completed on 30 participants from the intervention group who are actively taking DMARD medication for RA to test the acceptability and feasibility of the PE2MAP.
RESULTS: The mean age and disease duration of the 30 participants were 52.63 and 8.50 years, respectively. The feasibility data showed 87% (n=26) completed the 4-week web-based PE2MAP intervention, 57% (n=17) completed all 100% of the contents, and 27% (n=8) completed 96% to 74% of the contents, indicating the overall feasibility of the intervention. As a whole, 96% (n=24) of the participants found the information on managing the side effects of medications, keeping fit, managing flare-ups, and monitoring joint swelling/pain/stiffness as the most useful contents of the intervention. In addition, 88% (n=23) and 92% (n=24) agreed that the intervention improved their adherence to medications and management of their side effects, including confidence in communicating with their health care team, respectively. The dos and do nots of traditional Chinese medicine were found by 96% (n=25) to be useful. Goal setting was rated as the least useful skill by 6 (23.1%) of the participants.
CONCLUSIONS: The web-based PE2MAP intervention was found to be acceptable, feasible, and effective as a web-based tool to empower patients with RA to manage and adhere to their DMARD medications. Further well-designed randomized controlled trials are warranted to explore the effectiveness of this intervention in the management of patients with RA.