Concerns & Misconceptions

Concerns/Misconceptions about MDHAQ/RAPID3

Correct Understanding of MDHAQ/RAPID3

A. Concerns/misconceptions about information from MDHAQ/RAPID3

1. “I can tell when my patient is better, so I don’t need a formal questionnaire.”

Although questionnaire responses usually confirm clinical impressions, discordance between patient and physician global estimates of status is common.

2. “I can get all the information I need about therapies from clinical trials.”

Data from clinical trials apply to groups, not necessarily to individuals, who very in responses over a wide range that should be recognized.

3. “I don’t want a patient questionnaire to replace examining the patient.”

A patient questionnaire never replaces examining the patient.

4. “I don’t want a patient questionnaire to interfere with doctor-patient communication and replace conversation.”

A patient questionnaire never replaces conversation with the patient and enhances doctor-patient communication by preparing the patient and doctor for the encounter.

5. “I want to take the patient history—not get it from a patient questionnaire.”

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

6. “RAPID3 responses should not be used to trigger automatic therapeutic decisions.”

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.

B. Concerns/misconceptions about MDHAQ/RAPID3 in office practice

1. “Patient questionnaires add extra time and interfere with patient flow.”

No evidence for this if questionnaire distributed by the receptionist to each patient at each visit.

2. “Many patients will object to completing questionnaires.”

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.

3. “Patient questionnaire should be used only at certain intervals rather than at each visit.”

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.

4. “An MDHAQ cannot be completed by patients of loweducation level.”

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.

5. “Electronic data capture is invariably more effective than pencil and paper.”

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.

C. Concerns/misconceptions about self-report versus traditional measures

1. “Patient questionnaire data don’t give me as good information to guide clinical decisions and prognosis as traditional radiographic or laboratory measures.”

Actually, patient questionnaires are more sensitive to change than laboratory tests or joint counts in most patients and more significant in prognosis.

2. “How can I monitor a patient quantitatively without a joint count?”

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.

3. “Patient questionnaire scores are influenced by irreversible damage, so they are not sensitive to control of inflammation, unlike joint counts.”

All measures in patients with RA are less likely to change in patients who have irreversible damage, including joint counts and questionnaires.

4. “I don’t want an index that does not include a doctor measure.”

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.