„Treat-To-Target“ aus der Sicht der niedergelassenen Rheumatologie

Krüger, Klaus; Karberg, Kirsten

doi:10.1007/s00393-011-0852-0

Cited by 10 publications

(7 citation statements)

References 15 publications

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“…Comparing the number of RA patients in Austria and their general practitioner (GP) counterparts makes it evident that an Austrian primary care physician is confronted with 0.4 incident patients with RA per year (that is, dividing the number of office-based GPs by the number of incident RA patients in Austria). This number is in line with published German studies [7, 8]. It is well established that diagnostic accuracy is a function of frequency - and for diseases as infrequent as RA a variety of approaches exist that try to stimulate more rapid and integrated cooperation between GPs and specialists [9–11].…”

Section: Introductionsupporting

confidence: 80%

Improving patient flow of people with rheumatoid arthritis has the potential to simultaneously improve health outcomes and reduce direct costs

Puchner

Hochreiter

Pieringer

et al. 2017

BMC Musculoskelet Disord

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BackgroundIn our current economic climate of scarce resources there is a lot of debate around the best - and most efficient - way of delivering care, which points patients towards the right physician at the earliest opportunity.The aim of the study was to assess whether an improvement in the interdisciplinary management of rheumatoid arthritis (RA) has the potential to simultaneously improve health outcomes and reduce costs.MethodsIn a first step, we modelled the ways which lead patients with RA to the correct diagnosis, and the relevant specialist, respectively. On average, a patient experiences 3 GP visits before referral to a specialist. We compared this situation against a reconfiguration of current practice towards a more proactive identification and referral method with initiation of care by a rheumatologist early in the disease. We evaluated the impact of this reconfiguration on the number of RA patients diagnosed and the costs associated with the diagnostic process.ResultUsing data on epidemiology and Austrian practice patterns, we estimate a total of 5294 people with undifferentiated arthritis per year, of which 1765 suffer from RA. Modelling for diagnostic accuracy, we found that 1200 of these patients are initially misdiagnosed in a primary care setting and 95 at a rheumatologist. Our model found that a reconfiguration of current practice towards an approach of more integrated care has the potential to be not only cost-effective, but cost-saving: EUR 100,188 could be saved annually by exclusively adopting the new approach.ConclusionsOur results show that by better directing the flow of people with RA, simultaneous clinical and economic benefits may be reaped:.

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Section: Introductionsupporting

confidence: 80%

Improving patient flow of people with rheumatoid arthritis has the potential to simultaneously improve health outcomes and reduce direct costs

Puchner

Hochreiter

Pieringer

et al. 2017

BMC Musculoskelet Disord

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“…The implementation of guidelines in rheumatology clinical practice has been shown to be a challenge. Studies in rheumatoid arthritis indicate that there is a discrepancy between the reported acceptance of guidelines and the application of these in clinical practice [ 16 , 17 ]. The IRIS study even showed that despite participation in 2 years of educational training, rheumatologists seem to be reluctant to apply recommendations in real-life clinical practice [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Residual disease activity and treatment adjustments in psoriatic arthritis in current clinical practice

et al. 2017

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BackgroundWith expanding therapeutic possibilities for treatment of psoriatic arthritis (PsA) it will be increasingly important to determine residual disease and define when to adjust treatment. The rationale behind treatment decisions in current daily clinical practice and the relationship with residual disease activity has not been investigated. The aim of this study was to assess current clinical practice on defining residual disease and subsequent treatment decisions made in PsA patients.MethodsThis cross-sectional study scored disease activity and treatment decisions prospectively in 142 consecutive PsA patients visiting the outpatient clinic for routine follow up. Disease activity parameters were scored by patient and the treating rheumatologist; the rheumatologist additionally registered his opinion on the presence of remaining disease activity despite current treatment (further mentioned as remaining disease) and subsequent treatment decisions.ResultsTwo thirds (90/142) of patients had remaining disease activity according to the treating rheumatologist. Almost half (46%) of these patients had moderate to high disease activity according to the clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA). Residual disease activity was determined by joint disease and pain rather than by active psoriasis. Demographic and clinical features were similar between groups with or without residual disease. Among patients with remaining disease activity, 74% were treated with either a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) only or a first TNF-inhibiting biological agent, suggesting opportunities for treatment modification. However, treatment adjustment was initiated in only 21 (23%) of the 90 patients with residual disease. When comparing patients with remaining disease activity with and without treatment adjustment, we found no differences in objective disease activity measures, such as joint counts and patient scores. These data suggest that treatment is not adjusted in a large majority of patients with residual disease activity, although options for treatment changes are available.ConclusionsRemaining disease activity is present in almost two thirds of patients with PsA when scored by the treating rheumatologist, but triggers treatment adjustment in only a minority. Further research to understand why disease activity does not lead to treatment adjustment is required to enable implementation of treatment strategies in clinical practice.

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“…This could be improved by increasing the number of physicians, introducing structured patient information and increasing involvement of assistants and nurses. 30 With the development of therapeutic options like biologic agents rheumatologists acknowledge the need to involve the patients in the treatment decisions, as this has been shown to improve their adherence to therapy. 31 Another driver to implement the concept of shared decision making could be the fact that patient participation is increasingly seen as a quality indicator for medical care within the German health care system.…”

Section: Discussionmentioning

confidence: 99%

Prioritizing the patient: optimizing therapy in rheumatoid arthritis. Results of a patient questionnaire in northern Germany

Wollenhaupt

Ehlebracht-Koenig²,

Groenewegen

et al. 2013

OARRR

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PurposeA 40-question postal survey was developed to gain insight into the nature of difficulties experienced by patients due to rheumatoid arthritis (RA), as well as patient perceptions and priorities regarding their RA treatmentPatients and methodsA total of 3000 Lower Saxony, Germany members of Rheuma-Liga (RL), a patient support group for people with RA, were invited to participate between July 1, and August 20, 2009. The questionnaire was divided into four sections: (1) patient demographics, (2) quality of life (QOL), (3) treatment expectations and, (4) patient perceptions of RL. The questionnaire could be completed in writing or via the internet.ResultsOf 959 respondents (response rate = 32.0%), 318 had diagnosed RA and were included in the analysis. The respondents were mostly retired (71.2%), female (83.3%), and >60 years of age (63.5%). Members’ responses indicated that most were generally satisfied with their current treatment (67.3%), considered it efficacious (84.0%), and reported minimal (none or little) side-effects (61.2%). Patient involvement in treatment decisions, however, was reportedly low (49.6% felt insufficiently involved). Patients’ primary impairments were reflected in their treatment priorities: mobility (97.0%), ability to run errands/do shopping (97.1%), do the housework (95.6%), and be independent of others (94.2%). The primary service provided by RL and used by respondents was physiotherapy (70.6%), which was reported to benefit physical function and mood by over 90.0% of respondents.ConclusionRA had a detrimental effect upon respondents’ quality of life, specifically impairing their ability to perform daily tasks and causing pain/emotional distress. Independence and mobility were strong priorities for respondents. Physical therapy, provided by RL, was felt to help both physical and mental/emotional health.

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„Treat-To-Target“ aus der Sicht der niedergelassenen Rheumatologie

Cited by 10 publications

References 15 publications

Improving patient flow of people with rheumatoid arthritis has the potential to simultaneously improve health outcomes and reduce direct costs

Improving patient flow of people with rheumatoid arthritis has the potential to simultaneously improve health outcomes and reduce direct costs

Residual disease activity and treatment adjustments in psoriatic arthritis in current clinical practice

Prioritizing the patient: optimizing therapy in rheumatoid arthritis. Results of a patient questionnaire in northern Germany

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