Utjecaj aktivnosti bolesti i funkcionalne onesposobljenosti bolesnika s reumatoidnim artritisom na razinu zadovoljstva pruženom reumatološkom uslugom

Darija Čubelić, Mirna Reihl Crnogaj, Miroslav Mayer

Rheumatoid arthritis (RA ) is a disease that requires regular monitoring of therapeutic efficacy and patients’ quality of life (QOL ). The aim of this study is to determine the influence of disease activity and duration, as well as functional disability, on the patients’ perception of satisfaction with the provided care, and to evaluate the satisfaction with respect to the patient-physician relationship and the factors that affect the patients’ satisfaction level. The observational non-interventional study included 53 consecutive RA patients who regularly attend the outpatient clinic. Prior to the scheduled examination the patients completed a standardized Patient Satisfaction Questionnaire and a Health Care Assessment Questionnaire (HAQ). The patients were divided according to their HAQ score, disease activity measured by DAS 28 score (Disease Activity Score 28), disease duration, and presence of bDMARD s
(biologic disease-modifying antirheumatic drugs) in therapy. The results showed that the patients were largely satisfied with the service provided. The highest scores were achieved in the categories of the technical quality and competence of the physician and the doctor’s attitude towards the patient. The lowest scores were related to the inability of an easy telephone access or emergency consultation and to the time spent in the waiting room. The level of disease activity did not significantly affect the degree of satisfaction with the provided health care. Additionally, patients who were classified as having severe to very severe disability by HAQ score had slightly lower satisfaction rates in all examined categories. Furthermore, patients treated wit bDMARD s and those with disease lasting more than five years reported higher satisfaction rates in all categories. In conclusion, patients with a higherm degree of disability experience a slightly lower level of satisfaction with medical care, whereas patients with long-standing disease and those treated with bDMARD s report higher levels of satisfaction with the specialist care. Satisfaction with the professional service provided in the specialist rheumatology unit can contribute to the improvement of the patients’ perception of satisfaction with QOL.

Reumatoidni artritis (RA ) bolest je koja nalaže kontinuirano praćenje učinkovitosti liječenja i kvalitete života bolesnika. Ciljevi istraživanja bili su utvrđivanje utjecaja aktivnosti bolesti na percepciju zadovoljstva bolesnika, evaluacija zadovoljstva bolesnika odnosom liječnik – pacijent te identifikacija čimbenika koji utječu na razinu zadovoljstva. Ova presječna opservacijska neintervencijska studija obuhvatila je 53 konsekutivna bolesnika s RA koji su dolazili na redovite ambulantne preglede u Zavod za kliničku imunologiju i reumatologiju. Bolesnici su prije pregleda ispunili standardizirani Upitnik o zadovoljstvu pacijenata te Upitnik o procjeni općega zdravstvenog stanja (HAQ). Ispitanici su podijeljeni u skupine prema vrijednostima rezultata HAQ-a, aktivnosti bolesti i njezinu trajanju te ovisno o tome primaju li biološku terapiju. Rezultati istraživanja pokazali su da su bolesnici uvelike zadovoljni pruženom uslugom. Najviše ocjene postignute su u kategorijama tehničke kvalitete i kompetentnosti liječnika te odnosa liječnika prema bolesniku. Najniže ocjene zadovoljstva odnosile su se na nemogućnost jednostavnoga telefonskog pristupa ili izvanredne konzultacije te na duljinu čekanja u čekaonici. Razina aktivnosti bolesti mjerena prema DAS 28-SE (engl. Disease Activity Score 28) nije bitno utjecala na stupanj zadovoljstva bolesnika pruženom uslugom. Nadalje, bolesnici koji su prema HAQ-u ubrojeni u skupinu teške do vrlo teške onesposobljenosti javili su diskretno niži stupanj zadovoljstva u svim ispitivanim kategorijama. Također, bolesnici liječeni biološkim lijekovima i oni s trajanjem bolesti duljim od 5 godina pokazali su više razine zadovoljstva u svim kategorijama. Zaključno, bolesnici s višom razinom funkcionalne onesposobljenosti izrazili su nešto nižu razinu zadovoljstva pruženom skrbi u reumatološkoj poliklinici, dok su bolesnici s dugotrajnom bolesti, kao i oni liječeni biološkom terapijom izrazili veće zadovoljstvo pruženom skrbi. Zadovoljstvo pacijenata specijalističkom uslugom pridonosi njihovu većem zadovoljstvu kvalitetom života.