Agner R Parra Sánchez, Koen Vos, Odile van Hall, Irene E M Bultink, Michel Tsang-A-Sjoe, Alexandre Voskuyl, Ronald F van Vollenhoven
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Usability was assessed with the System Usability Scale (SUS), completed by physicians in the T2T-CDSS group. Acceptability was evaluated using the Treatment Satisfaction Questionnaire (TSQ) and qualitative feedback. Exploratory outcomes included disease activity, remission rates and treatment modifications.</p><p><strong>Results: </strong>Of 91 screened patients, 38 were enrolled (recruitment rate 42%) and 35 completed the study (retention rate 92%). The SUS score for the CDSS was 73.8, indicating good usability. Global satisfaction scores on the TSQ were stable over time and comparable between groups. Remission was achieved at least once by 61% (11/18) of patients in the T2T-CDSS group and 59% (10/17) in the ROC group. Both treatment intensifications and de-escalations occurred more frequently in the T2T-CDSS group compared with ROC (83% vs 47%). Treatment intensifications were observed in 61% of patients in the T2T-CDSS group vs 29% in the ROC group. Treatment de-escalation, represented by glucocorticoid tapering, occurred in 39% of T2T-CDSS patients compared with 18% in ROC. No statistically significant differences were observed between groups in disease activity outcomes or remission rates.</p><p><strong>Conclusions: </strong>Implementation of a T2T strategy supported by a CDSS in SLE outpatient care was feasible, usable and acceptable to patients and physicians. 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引用次数: 0
摘要
目的:评估临床决策支持系统(CDSS)支持下治疗到目标(T2T)策略在常规SLE门诊治疗中的可行性、可用性和可接受性。方法:在四个风湿病门诊中心进行了一项为期24周、非随机、多中心、聚类的初步研究。成年SLE患者由中心分配到T2T策略支持CDSS (T2T-CDSS)或常规门诊护理(ROC)组。CDSS提供了基于疾病活动度测量的循证治疗建议。可行性结果包括招聘率和留任率。可用性评估采用系统可用性量表(SUS),由T2T-CDSS组的医生完成。采用治疗满意度问卷(TSQ)和定性反馈评估可接受性。探索性结果包括疾病活动性、缓解率和治疗修改。结果:91例筛查患者中,38例入组(招募率42%),35例完成研究(保留率92%)。CDSS的SUS得分为73.8,表明可用性良好。随着时间的推移,TSQ的全球满意度得分是稳定的,并且各组之间具有可比性。T2T-CDSS组中61%(11/18)的患者缓解至少一次,ROC组中59%(10/17)的患者缓解至少一次。与ROC相比,T2T-CDSS组的治疗强化和缓解更频繁(83% vs 47%)。T2T-CDSS组61%的患者观察到治疗强化,而ROC组为29%。以糖皮质激素减量为代表的治疗降级发生在39%的T2T-CDSS患者中,而在ROC中为18%。在疾病活动结果或缓解率方面,两组之间没有统计学上的显著差异。结论:CDSS支持的T2T策略在SLE门诊护理中的实施是可行的,可用的,并且对患者和医生都是可接受的。尽管定性反馈揭示了在未来的试验中应该解决的重要实施障碍,但干预促进了前瞻性的、目标驱动的治疗调整,而不影响患者满意度,并显示出在SLE管理中实施目标导向治疗的希望。
Advancing treat-to-target in SLE: a pilot study using a clinical decision support system.
Objective: To evaluate the feasibility, usability and acceptability of implementing a treat-to-target (T2T) strategy supported by a Clinical Decision Support System (CDSS), in routine SLE outpatient care.
Methods: A 24-week, non-randomised, multicentre, clustered pilot study was conducted across four rheumatology outpatient centres. Adult patients with SLE were allocated by centre to either a T2T strategy supported by a CDSS (T2T-CDSS) or a routine outpatient care (ROC) group. The CDSS provided evidence-based treatment recommendations based on disease activity measures. Feasibility outcomes included recruitment and retention rates. Usability was assessed with the System Usability Scale (SUS), completed by physicians in the T2T-CDSS group. Acceptability was evaluated using the Treatment Satisfaction Questionnaire (TSQ) and qualitative feedback. Exploratory outcomes included disease activity, remission rates and treatment modifications.
Results: Of 91 screened patients, 38 were enrolled (recruitment rate 42%) and 35 completed the study (retention rate 92%). The SUS score for the CDSS was 73.8, indicating good usability. Global satisfaction scores on the TSQ were stable over time and comparable between groups. Remission was achieved at least once by 61% (11/18) of patients in the T2T-CDSS group and 59% (10/17) in the ROC group. Both treatment intensifications and de-escalations occurred more frequently in the T2T-CDSS group compared with ROC (83% vs 47%). Treatment intensifications were observed in 61% of patients in the T2T-CDSS group vs 29% in the ROC group. Treatment de-escalation, represented by glucocorticoid tapering, occurred in 39% of T2T-CDSS patients compared with 18% in ROC. No statistically significant differences were observed between groups in disease activity outcomes or remission rates.
Conclusions: Implementation of a T2T strategy supported by a CDSS in SLE outpatient care was feasible, usable and acceptable to patients and physicians. Although qualitative feedback revealed important implementation barriers that should be addressed in future trials, the intervention facilitated proactive, target-driven treatment adjustments without compromising patient satisfaction and shows promise for implementing goal-directed therapy in SLE management.
期刊介绍:
Lupus Science & Medicine is a global, peer reviewed, open access online journal that provides a central point for publication of basic, clinical, translational, and epidemiological studies of all aspects of lupus and related diseases. It is the first lupus-specific open access journal in the world and was developed in response to the need for a barrier-free forum for publication of groundbreaking studies in lupus. The journal publishes research on lupus from fields including, but not limited to: rheumatology, dermatology, nephrology, immunology, pediatrics, cardiology, hepatology, pulmonology, obstetrics and gynecology, and psychiatry.