ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 430

Implementation of a Treat-to-Target Remission Strategy for Rheumatoid Arthritis in Australian Public and Private Rheumatology Clinics – Identification of Clinician and Patient Barriers

Helen Benham1, Hedva Chiu2, Joanne Tesiram3, Peter Landsberg4, Andrew A. Harrison5, Peter Nash6, Ranjeny Thomas7 and Mieke van Driel8, 1The University of Queensland Faculty of Medicine, Brisbane, Australia, 2The University of Queensland Faculty of Medicine, Woolloongabba, Australia, 3Rheumatology, Princess Alexandra Hospital, Woolloongabba, Australia, 4Princess Alexandra Hospital, Woolloongabba, Australia, 5Department of Medicine, University of Otago Wellington, Wellington, New Zealand, 6University of Queensland, Brisbane, Australia, 7Diamantina Institute, Diamantina Institute University of Queensland, Brisbane, Australia, 8Primary Care Clinical Unit, The University of Queensland Faculty of Medicine, Herston, Australia

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords:

Session Information

Date: Sunday, November 5, 2017

Title: Rheumatoid Arthritis – Clinical Aspects Poster I: Treatment Patterns and Response

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Treat-to-target in rheumatoid arthritis (RA-T2T) improves outcomes for people living with RA. Implementing T2T in routine clinical practice however presents many challenges and an evidence practice gap has emerged.

Methods: Cross-sectional surveys were undertaken in parallel: A survey of RA patients and Australian rheumatologists. Agreement was measured using a 10-point Likert scale for RA-T2T recommendations and 5-point for use in daily practice. Questions related to willingness to alter practice, education and patient perceptions were included with free-text comments and thematic analysis undertaken.

Results: 85 rheumatologists and 107 patients responded. Surveys show the majority of patients have no knowledge of RA-T2T (91%) but report high levels of agreement with the recommendations (8.61 to 9.51). Patients are willing to try a T2T approach (88%) and would be specifically willing to increase blood tests (96%), have joint counts performed (87%) and use a patient-reported-outcome tool (83%). They are less willing to have more frequent appointments (66%) and to spend additional time discussing RA-T2T (69%). 48% of patients feel their RA treatment could be improved and 28% would like to be more involved in treatment decision making. For rheumatologists the mean level of agreement scores ranged from 7.32 to 9.33. Lowest level of agreement was with the recommendation that a disease activity score is required to guide care in routine practice (7.32). 50% of rheumatologists reported they very often/often use a score in daily practice. 44% do not think RA-T2T is necessary for every RA patient. Rheumatologists are willing to schedule more visits (88%), perform joint counts (84%), use a PRO for shared decision-making (76%) and spend time discussing RA-T2T (85%). They are less willing to calculate a disease activity score (64%). Free text identified four thematic barriers to implementation of RA-T2T identified by rheumatologists: time, patient acceptance and adherence to medication change, lack of appointment availability and the lack of a rheumatology nurse in the clinic.

Conclusion: RA-T2T is an evidence-based intervention and is recommended for the management of RA. Agreement with some aspects of RA-T2T and uptake in routine clinical practice by Australian rheumatologists is low and the majority of patients are unaware of RA-T2T. Significant clinician and patient barriers exist and an implementation strategy utilizing an electronic and patient-driven knowledge-translation tool, for use at the point of care, is being created and tested for usability in Australian rheumatology clinics.

Disclosure: H. Benham, AbbVie, 2,AbbVie, 8; H. Chiu, None; J. Tesiram, None; P. Landsberg, None; A. A. Harrison, AbbVie, 8; P. Nash, None; R. Thomas, Janssen Pharmaceutica Product, L.P., 2,Janssen Pharmaceutica Product, L.P., 5; M. van Driel, None.

To cite this abstract in AMA style:

Benham H, Chiu H, Tesiram J, Landsberg P, Harrison AA, Nash P, Thomas R, van Driel M. Implementation of a Treat-to-Target Remission Strategy for Rheumatoid Arthritis in Australian Public and Private Rheumatology Clinics – Identification of Clinician and Patient Barriers [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/implementation-of-a-treat-to-target-remission-strategy-for-rheumatoid-arthritis-in-australian-public-and-private-rheumatology-clinics-identification-of-clinician-and-patient-barriers/. Accessed .

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