ABSTRACT
BACKGROUND: Biologics are known to entail specific risks (e.g. infections). Patients should possess self-care safety skills to develop appropriate behaviors in situations of risks (e.g. fever). To date, there is no adequate tool to assess these skills. OBJECTIVES: To elaborate a questionnaire to measure knowledge and skills regarding safety issues, for patients treated by biologics. METHODS: Three-step process. (1) A steering group of 10 rheumatologists, one pharmacist and two allied health professionals elaborated an exhaustive list of safety skills. Through a 3-round Delphi process involving the steering group, 14 patients on biologics and 14 other allied health professionals, the list of skills was reduced. (2) A corresponding series of questions and of clinical situations with multiple-choice answers were designed. (3) Preliminary validation was performed against the physician's opinion on skills, and reliability was assessed. RESULTS: The list includes 24 skills e.g. how to deal with fever, planned surgery, dental care, travel, minor traumas, and immunizations. A 55-question questionnaire was constructed. Preliminary validation (62 patients) showed the questionnaire was filled in 10 minutes (median) and correlated to the physician's opinion of skills (R=0.47, P<0.0001) but not to disease status or disease duration. The median score was 75% (range 20%-96%). The questionnaire was reliable: intraclass correlation coefficient, 0.83 (95% CI: 0.63-0.93). CONCLUSION: A simple (multiple-choice questionnaire) and valid tool investigating a core set of safety skills has been developed. This tool could be useful to detect further educational needs regarding biologics safety, and to assess the efficacy of oriented educational interventions.
Subject(s)
Arthritis/therapy , Biological Therapy , Self Care/standards , Adult , Biological Therapy/adverse effects , Cross-Sectional Studies , Delphi Technique , Female , Humans , Male , Middle Aged , Patient Safety , Surveys and QuestionnairesABSTRACT
OBJECTIVES: High-quality medical records that contain detailed data on the patient and disease are essential to high-quality patient care. RHEVER is a network of hospital- and office-based rheumatologists created in 1999 to pursue a number of objectives, including the development of recommendations about items that should be recorded routinely at each patient visit. Subsequently, one of the RHEVER members investigated whether these recommendations were followed by RHEVER participants at a teaching hospital. METHODS: A cross-section of paper-based outpatient files at the rheumatology clinic of the Cochin Teaching Hospital, Paris, France, was studied. The sample comprised 50 files taken at random and 30 files of patients with rheumatoid arthritis. RESULTS: In the 50 unselected files, the reason for the visit was consistently provided, but the diagnosis was variably recorded and decisions about investigations and treatments were not always described. Of the 30 files in patients with rheumatoid arthritis, 75% contained the full set of recommended clinical items. CONCLUSION: This pilot study establishes the feasibility of practice pattern evaluation by rheumatologists. A similar study should be conducted among office-based RHEVER participants. Follow-up investigations are needed to evaluate the impact of medical record evaluations on quality of care.
