Using video‐based training for button‐free auto‐injection of subcutaneous methotrexate: A pilot study

Homer, Dawn

doi:10.1002/msc.1420

Cited by 4 publications

(14 citation statements)

References 17 publications

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“…Switching could have had the advantage that some biologics have better adherence with self-administration [ 40–42 ]. Although self-training for injection via video has generally been well received, rheumatologists might have postponed initiation until in-person training could take place [ 41 ]. Even with training, self-injection is not suitable for some patients owing to limited dexterity or patient preference [ 42–44 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries

Machado

Verschueren

Grainger

et al. 2022

Rheumatology Advances in Practice

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Objectives We aimed to describe, from the perspective of rheumatologists in Europe, how the COVID-19 pandemic has impacted their management of people with rheumatoid arthritis (RA) and the continuing medical education of physicians. Methods Rheumatologists participating in the Adelphi RA Disease Specific Programme™ in six European countries were contacted in August and September 2020 for a telephone survey. Rheumatologists were asked seven attitudinal questions on changes to patient management, prescription behaviour, and continuing education due to COVID-19. Results were summarised with descriptive statistics. Results The telephone survey was completed by 284 rheumatologists. The most commonly reported changes to patient management were increased utilisation of video/telephone consultations (66.5% of respondents), fewer visits (58.5%), and limiting physical contact (58.1%). Furthermore, 67.9% of rheumatologists who indicated prescribing behaviour had changed switched their patients to self-administered medication and 60.7% reported not starting patients on targeted synthetic disease-modifying antirheumatic drugs (DMARDs), biologic originator DMARDs, or biosimilar DMARDs. In total, 57.6% of rheumatologists believed changes in management would persist. Rheumatologists reported that 38.0% of patients expressed concerns about how COVID-19 would impact treatment, including access to treatment and the risk of infection. The biggest impact on rheumatologist education was a switch to online training and conferences. Conclusions All countries saw changes in patient management and prescribing behaviour, including the rapid uptake of telemedicine. It is important that the international rheumatology community learns from these experiences to better prepare for future pandemics and to address ongoing rheumatologist shortages. Lay Summary What does this mean for patients ? We asked rheumatologists a series of questions to find out how COVID-19 affected the way they interact with their patients with rheumatoid arthritis. We found that rheumatologists switched to online or telephone appointments in most countries to obey social distancing rules. Rheumatologists also reduced prescription of advanced medicines, most likely as a response to patient fears that such therapies may increase infection risk. There were differences between countries in changes made to patient treatment likely caused by differences in COVID-19 case numbers and where patients saw their doctor. We also found that doctor education moved mostly online. These results will help guide doctors in case of future pandemics as well as helping to plan future studies into how online appointments may be best used, who they are suitable for, and how they may be used to ensure patients can see a rheumatologist when they need to. They also highlight a need for continued monitoring of patients to ensure medication changes do not reduce effectiveness of treatment in the long-term.

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Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries

Machado

Verschueren

Grainger

et al. 2022

Rheumatology Advances in Practice

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“…Despite participants being generally satisfied with subcutaneous MTX, their autonomy could be limited if the rheumatic disease affected their hands. This aspect should undoubtedly be considered when developing new devices, and initiatives for providing training in its use have already been launched (Homer, 2019).…”

Section: Discussionmentioning

confidence: 99%

Patient's experiences of the barriers and facilitators to Methotrexate

Otón

Carmona

Andreu

2021

Musculoskeletal Care

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Objective To investigate the barriers and facilitators of adherence to methotrexate (MTX) in people with rheumatic diseases and to explore the experience of shared decision‐making. Methods A qualitative study was carried out. People diagnosed with inflammatory arthritides or systemic autoimmune diseases and who were treated with MTX were invited to participate in focus groups. The discourse was coded and synthesised with a content analysis approach. Results The groups included 12 representative patients (rheumatoid arthritis, spondylarthritis, and systemic lupus erythematosus, taking either oral or subcutaneous MTX). Four main themes were identified: (1) drug‐related aspects (package insert, adverse events, administration, and difficulties with treatment); (2) patient‐physician relationship; (3) social environment (lack of visibility of rheumatic diseases and the support of patient associations); and (4) medication and medical care practicalities (information, reliable sources, and expanding knowledge in other health areas). Conclusions Aspects identified might help improve adherence, including quality information, especially on adverse events, the role of the setting, and shared decision‐making.

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“…For example, self‐injection performance improved from 80% to 100% after training was provided to participants (46). In terms of the training method, one study reported that 91% of participants agreed that they could confidently perform self‐injection correctly without any assistance after viewing the self‐training video (52). On the other hand, the qualitative findings from one study revealed that participants appreciated help from a nurse for dealing with MTX when required: “[I am] grateful that I can always speak to a nurse over the MTX if necessary…” (51).…”

Section: Resultsmentioning

confidence: 99%

“…This construct concerns factors that the participant believes will impact their ability to use or adhere to treatment with MTX injections. Thirteen articles were coded to this construct (42–50,52,54–56), 4 of which used qualitative data (51,54–56). The pain associated with MTX injections, which could be a barrier, was mild to almost negligible in one study, as evidenced by a mean pain score of 3.6 on a 100‐mm visual analog scale (0 = no pain and 100 mm = the worst pain imaginable) (45).…”

Section: Resultsmentioning

confidence: 99%

“…The included studies had a variety of purposes and methods used. The majority (8 studies) were focused on usability and patient preference and used quantitative methods (42)(43)(44)(45)(46)(47)(48)(49), 1 was a quantitative survey study (50), 1 included a quantitative and qualitative survey (mixed-methods study) that investigated the experience of using subcutaneous MTX (51), 1 was a quantitative survey study regarding training on how to use MTX injection (52), 1 was a quantitative MTX adherence study (53), 2 were qualitative focus group studies discussing the barriers and enablers in the use of DMARDs in general (with specific findings presented about MTX) (54,55), and 1 was a qualitative in-depth interview study about medication use in early RA (56).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Barriers and Enablers in the Use of Parenteral Methotrexate in Rheumatoid Arthritis Patients: A Scoping Review

Tan

Reeve

Fraser

et al. 2023

Arthritis Care & Research

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ObjectiveMethotrexate (MTX) is effective in controlling disease activity in rheumatoid arthritis (RA). Parenteral MTX may have benefits over oral MTX, but it is rarely used in practice. To better understand this low usage rate, it is necessary to explore the barriers and enablers of therapy from the perspective of RA patients. The objectives of this scoping review were to describe RA patients’ perspectives on the barriers and enablers in the use of parenteral MTX and to identify the research gaps in this field.MethodsThe search was performed in Medline, Embase, Scopus, and Cochrane Library from inception to May 2021. Data synthesis was conducted using the Theoretical Framework of Acceptability. This scoping review included any type of study that explored the use of parenteral MTX by adult RA patients from the patients’ perspective, written in English.ResultsFifteen studies were included; findings related to the constructs “affective attitude,” “burden,” “intervention coherence,” and “self‐efficacy” were explored the most, while some were rarely (“opportunity cost” and “perceived effectiveness”) or not (“ethicality”) reported. RA patients were generally satisfied with MTX injections (“affective attitude”). From the burden construct, the requirement for dexterity for administering MTX by injection was considered a barrier, whereas the lack of significant pain from MTX injection was considered an enabler.ConclusionThe findings suggested that patients generally preferred parenteral MTX formulations with attributes that facilitate self‐administration. However, much of the identified research focused on prefilled pen devices, and significant gaps were identified, such as a lack of qualitative research.image

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Using video‐based training for button‐free auto‐injection of subcutaneous methotrexate: A pilot study

Cited by 4 publications

References 17 publications

Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries

Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries

Patient's experiences of the barriers and facilitators to Methotrexate

Barriers and Enablers in the Use of Parenteral Methotrexate in Rheumatoid Arthritis Patients: A Scoping Review

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