A patient‐centered knowledge translation tool for treat‐to‐target strategy in rheumatoid arthritis: Patient and rheumatologist perspectives

Abstract

Aim Implementation of treat‐to‐target (T2T) for rheumatoid arthritis (RA) presents many challenges and an evidence‐practice gap has emerged. This study assessed clinician and patient barriers to the implementation of an RA‐T2T strategy and developed a knowledge translation (KT) tool for use in “real‐life” clinical settings. Methods Surveys of patients and rheumatologists measured agreement with RA‐T2T recommendations and use in daily practice. Patient knowledge and perceptions were assessed as was clinician willingness to alter practice and barriers to RA‐T2T using visual analog scales. An electronic KT‐tool was developed and a two‐phase usability trial undertaken to assess use in clinical interactions. Results Ninety‐one percent of patients had no prior knowledge of RA‐T2T but agreed with the recommendations showing mean level agreement scores (8.39‐9.54, SD 2.37‐1.54). Ninety percent were willing to try RA‐T2T, 49% felt their treatment could be improved and 28% wanted more involvement in treatment decisions. Rheumatologists agreed with RA‐T2T recommendations (7.30‐9.27, SD 2.59‐0.91). Barriers to implementation identified by rheumatologists included time, appointment availability and perceived patient reluctance to escalate medications. Usability experiences with the KT‐tool were tracked and clinicians reported it was easy to use (100%), resulted in a discussion of RA‐T2T (73%) and a target being set for 63% of consults. Patients reported they read (92%) and understood (87%) the information in the KT‐tool, and that a target was set in 62% of interactions. Conclusions RA‐T2T uptake in clinical practice may be improved through understanding local clinician and patient barriers and an implementation strategy utilizing a patient‐driven KT‐tool.

One year in review 2021: novelties in the treatment of rheumatoid arthritis

“…One year in review 2021: novelties in the treatment of rheumatoid arthritis E. Silvagni 1 , G. Sakellariou 2 , A. Bortoluzzi 1 , A. Giollo 3,4 , N. Ughi 5 , L. Vultaggio 1 , C.A. Scirè 1,6 Treatment novelties in RA / E. Silvagni et al…”

“…An Australian initiative has developed and tested a patient-centred knowledge translation tool for T2T in RA, providing usable information to engage patients in the process of care (6). A Maximum Difference Scaling exercise including patients with inflammatory arthritis from the Netherlands showed that the main factors associated with adherence to treatment were related to reducing symptoms, maintaining independency and shared decision making, while practical issues were least important for RA patients to adhere to medications (7).…”

“…• The most recent data regarding the global health of RA population indicate that, despite the extensive scientific knowledge on the treatment of RA, the translation of these into the community of patients with RA has not yet took place (2-5) . • The urgency of the emerging treatment of RA, rather than the availability of new drugs, appears to be to design and implement new treatment delivery strategies, with the involvement of patients to complete this process (6)(7)(8)(9)(10).…”

BSACI Registry for Immunotherapy (BRIT): Providing safe and effective immunotherapy for allergies and urticaria

“…The use of biologic treatment for severe CSU has gathered momentum in the UK NHS in recent years and is based on National Institute of Health and Clinical Excellence (NICE) guidelines. Recent UK experience suggests a requirement for multiple treatment courses in a majority of patients with severe CSU 8 and use of treat‐to‐target concept 9 may be better applied in biologic‐resistant cases. The BRIT registry provides an opportunity to generate such datasets prospectively to enable strategic planning of resource allocation for specialist allergy centres.…”