ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1561

Factors Influencing Implementation of Intensive Treatment Strategies for Early Rheumatoid Arthritis

Sabrina Meyfroidt1, Diederik De Cock1, Kristien Van der Elst2, Laura van Hulst3, Marlies Hulscher3, Johan Joly4, Rene Westhovens5 and Patrick Verschueren5, 1Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium, 2Department of Development and Regeneration, Neuro-musculo-skeletal Research Unit, University Hospitals KULeuven, Leuven, Belgium, 3Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands, 4University Hospitals Leuven on behalf of the CareRA Study Group, Leuven, Belgium, 5Rheumatology, University Hospitals KULeuven, Leuven, Belgium

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Factors Associated with Rheumatoid Arthritis

Session Type: Abstract Submissions (ARHP)

Background/Purpose: Despite the availability and demonstrated effectiveness of intensive treatment strategies for early rheumatoid arthritis (RA), a discrepancy seems to exist between theoretical acceptance and practical implementation. Limited studies have looked at factors influencing the implementation of intensive treatment strategies for early RA in daily practice. The purpose of this study was to explore and identify these factors across different healthcare settings in Flanders. 

Methods: This study involved rheumatologists, nurses and patients participating in the CareRA trial, a multicentre RCT comparing different intensive treatment strategies for early RA based on the original Cobra step down schedule with conventional DMARDs (MTX+Sulphasalazine, MTX+Leflunomide, MTX monotherapy) plus step-down glucocorticoids. Two qualitative research methods were used, including semi-structured interviews and observations at outpatient clinics. Each interview was recorded, transcribed literally and analyzed thematically. 

Results: We interviewed 26 rheumatologists, 6 nurses and 24 RA patients and observed interactions between 5 rheumatologists and their patients at consultation. Greatest facilitators reported by rheumatologists and nurses included available scientific evidence, personal faith in treatment strategy, colleague support and low cost of medication. For patients, trust in caregiver was a facilitator, as well as faith in the treatment strategy. Rheumatologists had no doubts about the value of MTX but some questioned the combination strategy, others the effectiveness or/and the dosage of individual compounds. Patients were only in doubt of glucocorticoids and MTX. Additional barriers for rheumatologists included fear for patients’ preconceptions, concerns of applicability to the individual patient, break in routine, interference with organizational structures and processes, time constraints and lack of financial support.

Conclusion: The factors emerging from our study highlight the complexity of implementing intensive treatment strategies for early RA in daily clinical practice. Future improvement strategies should capitalize on the facilitators identified while at the same time addressing the barriers. The generalizability of these findings to other health care systems needs further examination.

Disclosure:

S. Meyfroidt,
None;

D. De Cock,
None;

K. Van der Elst,
None;

L. van Hulst,
None;

M. Hulscher,
None;

J. Joly,
None;

R. Westhovens,
None;

P. Verschueren,
None.

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