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Concerns/Misconceptions about MDHAQ/RAPID3
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Correct Understanding of MDHAQ/RAPID3
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A. Concerns/misconceptions about information from MDHAQ/RAPID3
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1. “I can tell when my patient is better, so I don’t need a formal questionnaire.”
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Although questionnaire responses usually confirm clinical impressions, discordance between patient and physician global estimates of status is common.
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2. “I can get all the information I need about therapies from clinical trials.”
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Data from clinical trials apply to groups, not necessarily to individuals, who very in responses over a wide range that should be recognized.
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3. “I don’t want a patient questionnaire to replace examining the patient.”
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A patient questionnaire never replaces examining the patient.
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4. “I don’t want a patient questionnaire to interfere with doctor-patient communication and replace conversation.”
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A patient questionnaire never replaces conversation with the patient and enhances doctor-patient communication by preparing the patient and doctor for the encounter.
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5. “I want to take the patient history—not get it from a patient questionnaire.”
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The history must be taken by the doctor—the questionnaire saves time for the doctor when reviewed before seeing the patient by providing factual information and many pertinent negatives
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6. “RAPID3 responses should not be used to trigger automatic therapeutic decisions.”
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No measure or index alone, whether a laboratory test, radiograph, DAS28, CDAI, RAPID3, etc., triggers therapeutic decisions— all decisions are based on a synthesis of all available information by the doctor.
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B. Concerns/misconceptions about MDHAQ/RAPID3 in office practice
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1. “Patient questionnaires add extra time and interfere with patient flow.”
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No evidence for this if questionnaire distributed by the receptionist to each patient at each visit.
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2. “Many patients will object to completing questionnaires.”
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Of course, some people complain about anything that involves effort; when patients see that MDHAQ/RAPID3 is important in their care, they accept it, and many appreciate its value.
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3. “Patient questionnaire should be used only at certain intervals rather than at each visit.”
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This idea may sound good but is impossible to implement for the clinic receptionist; furthermore, data should be available at the time of change in medication to determine change in status; if there is a reason to see the patient, an MDHAQ/RAPID3 should be completed.
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4. “An MDHAQ cannot be completed by patients of loweducation level.”
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Of course, some patients have difficulty completing questionnaires, but even most illiterate patients usually have a “literacy partner” to help them simply to get to the clinic, who can help complete the questionnaire.
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5. “Electronic data capture is invariably more effective than pencil and paper.”
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Use of paper is generally far less expensive, as easy for patients to complete, and much easier to transfer information from patient todoctor at this time.
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C. Concerns/misconceptions about self-report versus traditional measures
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1. “Patient questionnaire data don’t give me as good information to guide clinical decisions and prognosis as traditional radiographic or laboratory measures.”
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Actually, patient questionnaires are more sensitive to change than laboratory tests or joint counts in most patients and more significant in prognosis.
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2. “How can I monitor a patient quantitatively without a joint count?”
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A careful joint examination may be sufficient—it matters a lot whether a patient has 2 vs. 12 swollen joints, which can be ascertained in 5 seconds, but not necessarily whether 1 vs. 2 or 11 vs. 12, which requires about 2 minutes to determine.
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3. “Patient questionnaire scores are influenced by irreversible damage, so they are not sensitive to control of inflammation, unlike joint counts.”
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All measures in patients with RA are less likely to change in patients who have irreversible damage, including joint counts and questionnaires.
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4. “I don’t want an index that does not include a doctor measure.”
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One should distinguish between a measure and a decision; a decision is always made by a doctor on the basis of all information, which may be improved by available measures, none of which alone dictates a decision.
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