Treating Rheumatoid Arthritis to Target: A Canadian Physician Survey

Abstract

Objective.To assess agreement and application of Treat to Target (T2T) recommendations in Canadian practice.Methods.A survey of Canadian rheumatologists was conducted on the recommendations of T2T, an international initiative toward reaching specific therapeutic goals in rheumatoid arthritis. Agreement with each recommendation was measured on a 10-point Likert scale (1 = fully disagree, 10 = fully agree). A 4-point Likert scale (never, not very often, very often, always) assessed application of each recommendation in current practice. Responders who answered “never” or “not very often” were asked whether they were willing to change their practice according to the particular recommendation.Results.Seventy-eight rheumatologists responded (24% of the 330 who were contacted). The average agreement scores ranged from 6.92 for recommendation #5 (the frequency of measures of disease activity) to 9.10 for recommendation #10 (the patient needs to be involved in the decision-making process). A majority of participants indicated that they apply the T2T recommendations in their practice. Recommendations dealing with frequency of visits and the use of composite measures received the highest number of “never” or “not very often” responses. Busy practices and lack of confidence in composite outcome measures were the main reasons for objections to certain components of the recommendations.Conclusion.Although a majority of Canadian rheumatologists agreed with and supported the T2T recommendations, there was resistance toward specific aspects of these recommendations. Efforts are needed to better understand the reasons behind identified disagreements. Action plans to encourage the application of T2T recommendations in Canada are in development.

A Paradigm Shift in Rheumatoid Arthritis over the Past Decade

“…However, such agreement does not necessarily mean that these physicians have implemented the recommendations in their practice. As with every set of recommendations, there are barriers regarding application in practice, mainly because of time or resource constraints (51). Overall, the T2T concept has become widely applicable and is commonly used in clinical practice.…”

Treating rheumatoid arthritis to target: Russian version of international guidelines for patients

“…Аналогичное исследование было проведено среди канадских ревматологов [64]. Анкетирование прошли 78 (24%) из 330 опрошенных врачей.…”

“…Наибольшая степень сог-ласия наблюдалась для общего принципа №1, а наимень-шая -для рекомендации №4. На ежегодном съезде АCR в ноябре 2012 г. были представлены данные канадской Руководящей группы экспертов Т2Т о восприятии канадцами с РА рекоменда-ций Т2Т для больных [65]. Оценивалась степень согла-сия с содержанием рекомендаций в зависимости от со-циально-демографических факторов и длительности за-болевания.…”

Development of a Canadian Core Clinical Dataset to Support High-quality Care for Canadian Patients with Rheumatoid Arthritis

“…Variability in data collection creates challenges in maintaining complete patient records and monitoring care provision, and may also be a source of unwarranted variation in the provision of care. For example, guidelines suggest that rheumatologists should apply a treat-to-target approach to RA care 3 ; however, this approach is inconsistently implemented outside the setting of clinical trials, largely because of inconsistencies in recording composite measures of disease activity 4,5 .…”