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Abstract
Objective
To examine the impact of patient education (PE) on patients' satisfaction in rheumatoid arthritis (RA) and to compare nurse-led education with medical doctor (MD)-led education.
Methods
Patients were enrolled by categorizing in two groups, nurse-led and MD-led education, randomization was performed. Face-to-face education was conducted two times, and changes in patient satisfaction before and after PE were assessed using the visual analogue scale (VAS; 0 to100 mm) and patients' satisfaction questionnaire (PSQ). Changes in patients' reported outcomes (PRO) were measured using disease activity score with 28 joint-erythrocyte sedimentation rate (DAS28-ESR), health assessment questionnaire (HAQ), and European quality of life-5 dimension (EQ-5D). Changes in patients' satisfaction and PRO between before and after PE were compared using paired t-test, and the comparison between nurse-led and MD-led education was analyzed using independent t-test.
Results
A total of 120 patients, 60 patients from each group, were randomized to receive either nurse-led or MD-led education. Among them, 113 patients completely received education and final assessment. In total patients, patients' satisfaction was significantly increased from 87.8±13.1 mm to 92.3±8.8 mm in VAS (p＜0.01), and from 3.7±0.4 to 4.0±0.4 in PSQ (p＜0.01). There was no improvement in DAS28-ESR, HAQ, but there was mild improvement in quality of life (QOL) after PE. Improvement of patients' satisfaction by PSQ after nurse-led education was 0.4±0.4 and it was higher than 0.3±0.5 after MD-led education, but it was not statistically different (p=0.25).
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Figure 1.
The flow of patient selection, randomization and follow-up. MD: medical doctor, RA: rheumatoid arthritis.
Figure 2.
The change of patients' satisfaction and disease outcomes before and after education. (A) Change in patients' satisfaction with VAS before and after education. (B) Change in patients' satisfaction with PSQ before and after education. PSQ: patients' satisfaction questionnaire, VAS: visual analogue scale.
Table 1.
Baseline characteristics of rheumatoid arthritis patients
Values are presented as median (range), number (%), or mean±standard deviation. BMI: body mass index, CCP: cyclic citrullinated peptides, CRP: C-reactive protein, DAS28: disease activity score with 28 joint, DMARDs: disease modifying antirheumatic drugs, ESR: erythrocyte sedimentation rate, HAQ-DI: health assessment questionnaire disability index, MD: medical doctor, MTX: methotrexate, RF: rheumatoid factor, VAS: visual analogue scale.
Table 2.
Comparison of the change of patients' satisfaction between nurse-led education and MD-led education
| PSQ | Total | Nurse-led education (n=60) | MD-led education (n=60) | p-value |
|---|---|---|---|---|
| General satisfaction | ||||
| Before education | 3.2±0.4 | 3.2±0.5 | 3.2±0.3 | 0.76 |
| After education | 3.4±0.4 | 3.3±0.4 | 3.4±0.3 | 0.26 |
| Change between pre and post-education | 0.2±0.4* | 0.1±0.5 | 0.2±0.3 | 0.32 |
| Giving of information | ||||
| Before education | 3.7±0.5 | 3.7±0.6 | 3.7±0.4 | 0.85 |
| After education | 4.2±0.4 | 4.2±0.4 | 4.1±0.4 | 0.38 |
| Change between pre and post-education | 0.4±0.5* | 0.5±0.5 | 0.4±0.5 | 0.28 |
| Empathy with the patient | ||||
| Before education | 3.8±0.5 | 3.8±0.6 | 3.8±0.5 | 0.36 |
| After education | 4.1±0.6 | 4.1±0.6 | 4.1±0.5 | 0.86 |
| Change between pre and post-education | 0.3±0.7* | 0.3±0.7 | 0.3±0.7 | 0.57 |
| Technical quality and competence | ||||
| Before education | 4.2±0.5 | 4.2±0.6 | 4.2±0.4 | 0.80 |
| After education | 4.4±0.5 | 4.5±0.6 | 4.4±0.5 | 0.35 |
| Change between pre and post-education | 0.2±0.7* | 0.3±0.7 | 0.2±0.6 | 0.33 |
| Attitude towards the patient | ||||
| Before education | 3.7±0.6 | 3.7±0.7 | 3.8±0.5 | 0.76 |
| After education | 3.9±0.6 | 4.0±0.7 | 3.9±0.6 | 0.30 |
| Change between pre and post-education | 0.2±0.6* | 0.3±0.7 | 0.1±0.6 | 0.20 |
| Access and continuity | ||||
| Before education | 3.6±0.5 | 3.6±0.6 | 3.6±0.5 | 0.74 |
| After education | 3.8±0.7 | 3.8±0.7 | 3.7±0.6 | 0.55 |
| Change between pre and post-education | 0.2±0.7* | 0.2±0.6 | 0.2±0.7 | 0.75 |
| Overall satisfaction | ||||
| Before education | 3.7±0.4 | 3.7±0.5 | 3.7±0.4 | 0.81 |
| After education | 4.0±0.4* | 4.0±0.4 | 4.0±0.4 | 0.43 |
| Change between pre and post-education | 0.3±0.4 | 0.3±0.4 | 0.2±0.4 | 0.26 |
Table 3.
The change of patient satisfaction according to patients' characteristics
Values are presented as mean±standard deviation. Patients group were classified according to disease duration and antirheumatic drugs. Group I: patients who were less than 2 years after RA diagnosis, Group II: patients who were more than 2 years after RA diagnosis, Group III: patients treated with biologic disease modifying antirheumatic drugs. PSQ: patients' satisfaction questionnaire, RA: rheumatoid arthritis, VAS: visual analogue scale.
Table 4.
Impact of patient education on patient reported outcomes according to educator
| Feature | Total (n=120) | p-value | Nurse-led group (n=60) | MD-led group (n=60) | p-value |
|---|---|---|---|---|---|
| DAS28-ESR | |||||
| Before education | 3.8±1.3 | 3.9±1.3 | 3.8±1.3 | 0.62 | |
| After education | 3.6±1.2 | 3.6±1.1 | 3.7±1.3 | 0.51 | |
| Improvement | 0.2±1.1 | 0.20* | 0.3±1.1 | −0.002±1.1 | 0.13 |
| HAQ-DI | |||||
| Before education | 0.6±0.6 | 0.7±0.6 | 0.5±0.5 | 0.16 | |
| After education | 0.7±0.6 | 0.7±0.6 | 0.6±0.6 | 0.17 | |
| Improvement | −0.07±0.44 | 0.07* | −0.05±0.53 | −0.10±0.35 | 0.63 |
| EQ-5D | |||||
| Before education | 0.8±0.1 | 0.8±0.1 | 0.8±0.1 | 0.56 | |
| After education | 0.8±0.1 | 0.8±0.1 | 0.8±0.1 | 1.00 | |
| Improvement | 0.02±0.12 | 0.01* | 0.04±0.11 | 0.01±0.14 | 0.19 |
Table 5.
Impact of patient education on patient reported outcomes according to patients' characteristics
Values are presented as mean±standard deviation. Group I: patients who were less than 2 years after RA diagnosis, Group II: patients who were more than 2 years after RA diagnosis, Group III: patients treated with biologic disease modifying antirheumatic drugs. MD: medical doctor, DAS28: disease activity score with 28 joint, ESR: erythrocyte sedimentation rate, HAQ-DI: health assessment questionnaire disability index, EQ-5D: European quality of life-5 dimension, RA: rheumatoid arthritis.
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