Romatoid artrit tedavisinde metotreksat’ın reçetelenmesi ve izlemine yönelik gereksinimler ve hastanın kendi kendine bakım süreci ile ilgili konsensüs geliştirilmesi

Bu çalışma, romatoid artrit tedavisinde metotreksat kullanımı ile ilgili olarak romatoloji uzmanlarının olası sorunlarını ve endişelerini ortaya çıkarmak ve bunun sonucunda iyi uygulama standartlarını belirleyen önerileri elde etmeyi amaçlamaktadır. Fikir birliğine ulaşabilmek için kullanılan yöntemlerden 4 tekrarlı Delphi tekniği, İskoçya’daki 38 romatoloji uzmanı ile gerçekleştirilmiştir. Katılımcıların fikirlerini, toplamda 42 sorudan oluşan ankette ve 9-kademeli Likert skalası kullanarak 1: Hiçbir şekilde katılmıyorum - 9: Tamamıyla katılıyorum ifade etmeleri istenmiştir. Her anket tekrarının sonucu analiz edilerek, her soruya verilen cevap katılımcıların sayısı ve yüzdesi ve de grup medyan skoru olarak belirtilmiştir. Çalışma, romatoloji uzmanları arasında metotreksat kullanım uygulamaları açısından farklılıklar olduğunu ortaya koymuştur. Katılımcıların metotreksat başlangıç dozu, doz arttırımları, izlem parametreleri açısından benzer şekilde hareket ettikleri gözlense de; izleme dair hususları, uzman hemşire dışında, diğer bir sağlık personeline devretme konusunda istekli olmadıkları belirtilmiştir. Diğer taraftan, romatoloji uzmanları bazı metotreksat yan etkilerinin izlemini hastalara bırakma fikrini desteklemektedir. Romatoloji uzmanlarının metotreksat kullanan hastaların izlemi konusundaki kriterlerindeki farklı tercihleri ve yerel rehberlerin değişkenlikleri, bakımın sağlanması konusunda farklı uygulamalara yol açmaktadır. Diğer sağlık çalışanlarının örneğin, aile hekimleri ve eczacılar multidisipliner olarak ortaklaşa bakım sürecinde rollerinin ve sorumluluklarının farkına varılması, güvenli ve etkin ilaç kullanımına, yakın hasta izlemine ve bakımın sürekliliğinin sağlanmasına yol açacaktır.

Anahtar Kelimeler:

metotreksat, romatoid artrit, Delphi tekniği, kendi-kendine bakım

Consensus Development on Requirements in Methotrexate Prescribing, Monitoring and Patient’s Self-Care in the Treatment of Rheumatoid Arthritis

The aim of the study was to identify potential problems and concerns of rheumatology specialists regarding methotrexate therapy and to obtain recommendations about good practice standards for methotrexate use in the treatment of rheumatoid arthritis. Four rounds of the Delphi technique were used for a consensus development among 38 rheumatology specialists in Scotland. The participants were asked to indicate their opinion for 42 questions in a total questionnaire using a 9-point Likert scale 1: strongly disagree to 9: strongly agree . The results of each round were analyzed and presented in numbers and percentages of participants answering for each questions and group median interquartile range scores. The survey revealed that there were variations in the practice of rheumatology specialists in the use of methotrexate therapy. The participants were practicing in a similar way in terms of methotrexate initial dose and dose increments, monitoring parameters; however they were not willing to delegate monitoring issues to other health care professionals, except nurse specialist. On the other hand, the rheumatologists supported the idea of delegation some of the monitoring issues regarding methotrexate side effects to the patients. Differences in preferences among rheumatology specialists on the criteria for monitoring patients receiving methotrexate treatment and the variability in local guidelines has led to different practices in the provision of care. Recognition of roles and delegation of certain responsibilities to the other health providers such as general practitioners and pharmacists in a multidisciplinary shared care would yield to safe and effective drug use, close monitoring, and continuity of care.

Keywords:

methotrexate, rheumatoid arthritis, Delphi technique, self-care,

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