1
|
Saraux A, da Mota LMH, Dixit S, Gibofsky A, Matsubara T, Mulvey A, Koehn C, Mortezavi M, Segovia M, Kessouri M. Impact of the COVID-19 Pandemic on People Living with Rheumatoid Arthritis: Experiences and Preferences in Accessing Healthcare Across Five Countries. Rheumatol Ther 2024; 11:257-268. [PMID: 38217796 PMCID: PMC10920583 DOI: 10.1007/s40744-023-00629-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/24/2023] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION The global coronavirus 2019 (COVID-19) pandemic created many challenges in healthcare provision. This study aimed to evaluate the global impact of the COVID-19 pandemic on people living with rheumatoid arthritis (RA). METHODS The RA Narrative COVID-19 survey was conducted online among people with RA who resided in Brazil, Canada, France, Japan, and the US from August to September 2021. The survey examined disease management, healthcare access and experiences, and participant preferences for interactions with their doctor. RESULTS Overall, 500 participants completed the survey: 100 each resided in Brazil, Canada, France, Japan, and the US. Emotional well-being was the aspect of disease management most reported to be negatively impacted by the pandemic (55% of participants); 'having more anxiety and/or stress' during the pandemic was the top factor that made controlling RA symptoms more difficult (49% of participants). In comparison, the top factor that made controlling RA symptoms easier was 'having a less busy schedule' (35% of participants). More participants had virtual appointments during versus pre-pandemic (53% vs. 13%, respectively) and participants were equally satisfied with the overall quality of care received via virtual and in-person appointments (76% of participants were 'satisfied' or 'very satisfied' with both). However, participants generally preferred in-person over virtual appointments, except for prescription refills, for which preferences were similar (39% vs. 36%, respectively). CONCLUSIONS This survey suggests that the COVID-19 pandemic did negatively impact some aspects of disease management for people living with RA but had positive impacts on the utilization of virtual care. Although participants generally preferred in-person appointments, these results position virtual care as an appropriate means for routine follow-ups.
Collapse
Affiliation(s)
- Alain Saraux
- Rheumatology Unit, University Hospital, Hôpital de La Cavale Blanche, Brest, France
| | - Licia Maria Henrique da Mota
- Unidade de Reumatologia, Universidade de Brasília, Brasília, Brazil
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Sanjay Dixit
- Division of Rheumatology, McMaster University, Hamilton, ON, Canada
| | - Allan Gibofsky
- Department of Medicine, Hospital for Special Surgery-Weill Cornell Medicine, New York, NY, USA
| | - Tsukasa Matsubara
- Department of Orthopaedic Surgery, Matsubara Mayflower Hospital, Kato, Japan
| | | | - Cheryl Koehn
- Arthritis Consumer Experts, Vancouver, BC, Canada
| | | | | | - Meriem Kessouri
- Pfizer France, 23-25 Avenue du Dr Lannelongue, 75668, Paris, France.
| |
Collapse
|
2
|
Bryant MJ, Munt R, Black RJ, Reynolds A, Hill CL. Joining forces to understand what matters most: qualitative insights into the patient experience of outpatient rheumatology care. Rheumatol Adv Pract 2023; 7:rkad068. [PMID: 37724315 PMCID: PMC10505502 DOI: 10.1093/rap/rkad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/10/2023] [Indexed: 09/20/2023] Open
Abstract
Objective People with rheumatic diseases are frequent, long-term attenders of health-care services. Their care experiences are central to improving services. The aim of this study was to explore real-world experiences and priorities of people attending outpatient rheumatology care and those of health-care professionals (HCPs) providing care. Methods This qualitative study consisted of five semi-structured focus groups. Participants included rheumatology outpatients (n = 16) of two tertiary teaching hospitals and HCPs (n = 14; rheumatologists, rheumatology trainees, physiotherapists, a specialty nurse and a pharmacist). Participants explored priorities when attending outpatient services, real experiences and aspirations for improving future care. Transcripts were coded using inductive and deductive thematic analysis. Results Seven key themes were identified: smooth flow of technical processes, care coordination, individualized care, information sharing, clinical excellence, patient empowerment and comprehensive care. The findings were aligned conceptually with quality standards in Australia and worldwide. Different sub-themes and prioritization of concerns emerged from patient and HCP subgroups. Highly prioritized themes for patients pertained to processes and technical aspects of care. HCPs focused on themes relating to non-technical aspects of service provision: information sharing, individualization of care, patient advocacy and empowerment. Conclusion This study captured valuable insights into the current experience of outpatient rheumatology care from the perspective of patients and HCPs. It informs a collective understanding of differing and shared priorities, positives of current care and areas requiring change. Themes derived from the study data can be conceptualized in terms of the process, content and impact of care. Such domains can be measured longitudinally by routine implementation of validated patient-reported experience measures in rheumatology.
Collapse
Affiliation(s)
- Madeleine J Bryant
- Rheumatology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network,, Woodville South, SA, Australia
- Rheumatology Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Rebecca Munt
- Nursing Education, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Adelaide Nursing School, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Rachel J Black
- Rheumatology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network,, Woodville South, SA, Australia
- Rheumatology Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Amy Reynolds
- Patient Research Partner
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, SA, Australia
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network,, Woodville South, SA, Australia
- Rheumatology Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
3
|
Bywall KS, Esbensen BA, Heidenvall M, Erlandsson I, Lason M, Hansson M, Johansson JV. Physical function and severe side effects matter most to patients with RA (< 5 years): a discrete choice experiment assessing preferences for personalized RA treatment. BMC Rheumatol 2023; 7:17. [PMID: 37400929 DOI: 10.1186/s41927-023-00341-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 06/21/2023] [Indexed: 07/05/2023] Open
Abstract
AIM Early assessment of patient preferences has the potential to support shared decisions in personalized precision medicine for patients with rheumatoid arthritis (RA). The aim of this study was to assess treatment preferences of patients with RA (< 5 years) with previous experience of inadequate response to first-line monotherapy. METHOD Patients were recruited (March-June 2021) via four clinics in Sweden. Potential respondents (N = 933) received an invitation to answer a digital survey. The survey included an introductory part, a discrete choice experiment (DCE) and demographic questions. Each respondent answered 11 hypothetical choice questions as part of the DCE. Patient preferences and preference heterogeneity were estimated using random parameter logit models and latent class analysis models. RESULTS Patients (n = 182) assessed the most important treatment attributes out of physical functional capacity, psychosocial functional capacity, frequency of mild side effects and likelihood of severe side effects. In general, patients preferred a greater increase in functional capacity and decreased side effects. However, a substantial preference heterogeneity was identified with two underlying preference patterns. The most important attribute in the first pattern was the 'likelihood of getting a severe side effect'. Physical functional capacity was the most important attribute in the second pattern. CONCLUSION Respondents focused their decision-making mainly on increasing their physical functional capacity or decreasing the likelihood of getting a severe side effect. These results are highly relevant from a clinical perspective to strengthen communication in shared decision making by assessing patients' individual preferences for benefits and risks in treatment discussions.
Collapse
Affiliation(s)
- Karin Schölin Bywall
- School of Health, Care and Social Welfare, Division of Health and Welfare Technology, Mälardalen University, Västerås, Sweden.
- Department of Public Health and Caring Sciences, Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden.
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Mats Hansson
- Department of Public Health and Caring Sciences, Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Jennifer Viberg Johansson
- Department of Public Health and Caring Sciences, Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
- Institute for Future Studies, Stockholm, Sweden
| |
Collapse
|
4
|
Direskeneli H, Karadag O, Ates A, Tufan A, Inanc N, Koca SS, Cetin GY, Akar S, Cinar M, Yilmaz S, Yilmaz N, Dalkilic E, Bes C, Yilmazer B, Sahin A, Ersözlü D, Tezcan ME, Sen N, Keser G, Kalyoncu U, Armagan B, Hacibedel B, Helvacioglu K, Cesur TY, Basibuyuk CS, Alkan S, Gunay LM. Quality of life, disease activity and preferences for administration routes in rheumatoid arthritis: a multicentre, prospective, observational study. Rheumatol Adv Pract 2022; 6:rkac071. [PMID: 36133962 PMCID: PMC9486987 DOI: 10.1093/rap/rkac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/10/2022] [Indexed: 11/22/2022] Open
Abstract
Objective We aimed to evaluate quality of life (QoL), disease activity, compliance to treatment, patient and physician preferences for route of administration (RoA), status of health and pain in RA patients starting advanced treatments or needing a switch, and the factors associated with patient preferences. Methods A multicentre, prospective, observational and 1-year follow-up study was conducted, between 2015 and 2020, in adult RA patients using advanced treatments for the first time or needing a switch in their current treatments. All the data collected were entered into electronic case report forms. DAS in 28 joints with ESR [DAS28-4(ESR)], EuroQol 5-Dimensional Questionnaire (EQ-5D), HAQ Disability Index (HAQ-DI), Compliance Questionnaire for Rheumatology (CQR-19), Work Productivity and Activity Impairment Instrument (WPAI) and Patient Global Assessment-Visual Analogue Scale (PGA-VAS) questionnaires were used for longitudinal assessments. Results Four hundred and fifty-nine patients were enrolled. Three hundred and eight patients (67.1%) attended the final study visit at 12 months and were included for comparative analyses. Irrespective of RoA, the disease activity and QoL improved significantly at 12 months, whereas compliance worsened. At baseline and 12 months, EQ-5D and DAS28-4(ESR) scores were significantly correlated (P < 0.001). The WPAI scores changed significantly in favour of better outcomes over 12 months after initiation of advanced treatment or switching (P < 0.001). A higher proportion of patients preferred an oral RoA, in comparison to physicians (53.6% vs 31.4%; P < 0.001). Patient and physician RoA preferences were independent of gender, age, disease duration, advanced treatment type and the EQ-5D-3L, DAS28-4(ESR), HAQ-DI, PGA-VAS and CQR-19 scores at baseline. Conclusion The oral route was more frequently preferred by patients compared with physicians, although patients’ preference rates showed a slight increase towards the end of the treatment, which might be an important factor for RA outcomes. Better control of disease activity and QoL were achieved at 12 months, regardless of RoA.
Collapse
Affiliation(s)
- Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Marmara University , Istanbul, Turkey
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University , Ankara, Turkey
| | - Askin Ates
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ankara University , Ankara, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University , Ankara, Turkey
| | - Nevsun Inanc
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Marmara University , Istanbul, Turkey
| | - Serdar S Koca
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fırat University , Elazıg, Turkey
| | - Gozde Y Cetin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kahramanmaras Sutcu Imam University , Kahramanmaras, Turkey
| | - Servet Akar
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Izmir Katip Celebi University , Izmir, Turkey
| | - Muhammet Cinar
- Clinic of Rheumatology, Gulhane Faculty of Medicine, Gulhane Training and Research Hospital, Health Science University , Ankara, Turkey
| | - Sedat Yilmaz
- Clinic of Rheumatology, Gulhane Faculty of Medicine, Gulhane Training and Research Hospital, Health Science University , Ankara, Turkey
| | - Neslihan Yilmaz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, TC Demiroglu Bilim University , Istanbul, Turkey
| | - Ediz Dalkilic
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludag University , Bursa, Turkey
| | - Cemal Bes
- Clinic of Rheumatology, Department of Internal Medicine, Istanbul Provincial Health Directorate, Basaksehir Cam and Sakura City Hospital , Istanbul, Turkey
| | - Baris Yilmazer
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Trakya University , Edirne, Turkey
| | - Ali Sahin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Cumhuriyet University , Sivas, Turkey
| | - Duygu Ersözlü
- Clinic of Rheumatology, Department of Internal Medicine, SBU Adana City Training and Research Hospital , Adana, Turkey
| | - Mehmet E Tezcan
- Division of Rheumatology, Department of Internal Medicine, Istanbul Provincial Health Directorate, Istanbul Kartal Dr. Lutfi Kırdar Training and Research Hospital , Istanbul, Turkey
| | - Nesrin Sen
- Division of Rheumatology, Department of Internal Medicine, Istanbul Provincial Health Directorate, Istanbul Kartal Dr. Lutfi Kırdar Training and Research Hospital , Istanbul, Turkey
| | - Gokhan Keser
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ege University , Izmir, Turkey
| | - Umut Kalyoncu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University , Ankara, Turkey
| | - Berkan Armagan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University , Ankara, Turkey
| | | | | | | | | | | | | |
Collapse
|
5
|
Quintana R, Fernandez S, Guggia L, Fay M, Camacho C, Gomez G, Petrelli J, Honeri A, Solórzano VA, Bensi A, Calvo ME, Pelaez-Ballestas I, Valdata M, Pons-Estel BA. Social networks as education strategies for indigenous patients with rheumatoid arthritis during COVID-19 pandemic. Are they useful? Clin Rheumatol 2022. [PMID: 35829932 DOI: 10.1007/s10067-022-06273-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/09/2022] [Accepted: 06/29/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The use of online education strategies has been introduced as a tool to support health care in patients with rheumatic disease. However, it is important to consider the patient's sociocultural environment. OBJECTIVE To design and assessment of bilingual audiovisual material acceptability, by means of two social networks, for patients with rheumatoid arthritis (RA) in the qom community in Argentina. METHODS A qualitative study was performed in two stages: (1) audiovisual material design, development, and validation implementing a collaborative action research method. (2) Publishing of the material on two social networks at two different times. The selected topic was the coronavirus disease 2019 impact on patients with RA. A qualitative and quantitative data analysis was performed. RESULTS Forty subjects participated into the initial validation stage with a 70% acceptance rate. First, 28 subjects (70%) participated on Facebook and 25 (62.5%) joined the WhatsApp group. Then, the same number of subjects participated on Facebook, while only 45% of subjects participated on WhatsApp. Most of them participated using short phrases such as "I like it." The 60% of the participants played the videos. However, less than 10% shared them. Videos in Spanish were the once most shared. Participation dramatically fell during the second time, and 40% of the WhatsApp subjects never participated. CONCLUSION The strategies developed for this indigenous community were of no utility, probably because of socio-cultural, economic, and digital barriers. They should be designed and implemented identifying the target group and its environment. Key Points • Online education strategies should be designed with cultural sensitivity. • Technological barriers make digital inequality visible in vulnerable groups. • Educational interventions should have a collaborative design and they should be created together with the communities. • The COVID-19 pandemic has deepened inequalities in the health care and follow-up of patients with rheumatic diseases, especially between most socially and economically disadvantaged groups.
Collapse
|
6
|
Bergman M, Tundia N, Martin N, Suboticki JL, Patel J, Goldschmidt D, Song Y, Wright GC. Patient-reported outcomes of upadacitinib versus abatacept in patients with rheumatoid arthritis and an inadequate response to biologic disease-modifying antirheumatic drugs: 12- and 24-week results of a phase 3 trial. Arthritis Res Ther 2022; 24:155. [PMID: 35751108 PMCID: PMC9229430 DOI: 10.1186/s13075-022-02813-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 05/13/2022] [Indexed: 01/22/2023] Open
Abstract
Background In previous clinical trials, patients with active rheumatoid arthritis (RA) treated with upadacitinib (UPA) have improved patient-reported outcomes (PROs). This post hoc analysis of SELECT-CHOICE, a phase 3 clinical trial, evaluated the impact of UPA vs abatacept (ABA) with background conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) on PROs in patients with RA with inadequate response or intolerance to biologic disease-modifying antirheumatic drugs (bDMARD-IR). Methods Patients in SELECT-CHOICE received UPA (oral 15 mg/day) or ABA (intravenous). PROs evaluated included Patient Global Assessment of Disease Activity (PtGA) by visual analog scale (VAS), patient’s assessment of pain by VAS, Health Assessment Questionnaire Disability Index (HAQ-DI), morning stiffness duration and severity, 36-Item Short Form Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Work Productivity and Activity Impairment (WPAI), and EQ-5D 5-Level (EQ-5D-5L) index score. Least squares mean (LSM) changes from baseline to weeks 12 and 24 were based on an analysis of covariance model. Proportions of patients reporting improvements ≥ minimal clinically important differences (MCID) were compared using chi-square tests. Results Data from 612 patients were analyzed (UPA, n=303; ABA, n=309). Mean age was 56 years and mean disease duration was 12 years. One-third received ≥2 prior bDMARDs and 72% received concomitant methotrexate at baseline. At week 12, UPA- vs ABA-treated patients had significantly greater improvements in PtGA, pain, HAQ-DI, morning stiffness severity, EQ-5D-5L, 2/4 WPAI domains, and 3/8 SF-36 domains and Physical Component Summary (PCS) scores (P<0.05); significant differences persisted at week 24 for HAQ-DI, morning stiffness severity, SF-36 PCS and bodily pain domain, and WPAI activity impairment domain. At week 12, significantly more UPA- vs ABA-treated patients reported improvements ≥MCID in HAQ-DI (74% vs 64%) and SF-36 PCS (79% vs 66%) and 4/8 domain scores (P<0.05). Conclusions At week 12, UPA vs ABA treatment elicited greater improvements in key domains of physical functioning, pain, and general health and earlier improvements in HAQ-DI. Overall, more UPA- vs ABA-treated patients achieved ≥MCID in most PROs at all timepoints; however, not all differences were statistically significant. These data, however, highlight the faster response to UPA treatment. Trial registration NCT03086343, March 22, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02813-x.
Collapse
Affiliation(s)
- Martin Bergman
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | | | | | | | | | - Yan Song
- Analysis Group, Inc., Boston, MA, USA.
| | - Grace C Wright
- Grace C Wright MD PC; Association of Women in Rheumatology; United Rheumatology, New York, NY, USA
| |
Collapse
|
7
|
Koike T. Painkillers in the treatment of inflammatory arthritis: past, present, and future. Rheumatology (Oxford) 2022; 61:3099-3100. [PMID: 35266514 DOI: 10.1093/rheumatology/keac153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tatsuya Koike
- Search Institute for Bone and Arthritis Disease (SINBAD), Shirahama Foundation for Health and Welfare, Nishimuro-gun, Shirahama-cho 1447, Wakayama, 649-2211, Japan.,Center for Senile Degenerative Disorders (CSDD), Osaka City University Medical School, Abeno-ku, Asahimachi 1-4-3, Osaka, 545-8585, Japan
| |
Collapse
|
8
|
Kahler J, Mastarone G, Matsumoto R, ZuZero D, Dougherty J, Barton JL. "It may help you to know…": The Early-phase Qualitative Development of a Rheumatoid Arthritis Goal Elicitation Tool. J Rheumatol Suppl 2022; 49:142-149. [PMID: 34210836 PMCID: PMC8720108 DOI: 10.3899/jrheum.201615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Treatment guidelines for rheumatoid arthritis (RA) include a patient-centered approach and shared decision making, which includes a discussion of patient goals. We describe the iterative early development of a structured goal elicitation tool to facilitate goal communication for persons with RA and their clinicians. METHODS Tool development occurred in 3 phases: (1) clinician feedback on the initial prototype during a communication training session; (2) semistructured interviews with RA patients; and (3) community stakeholder feedback on elements of the goal elicitation tool in a group setting and electronically. Feedback was dynamically incorporated into the tool. RESULTS Clinicians (n = 15) and patients (n = 10) provided feedback on the tool prototypes. Clinicians preferred a shorter tool deemphasizing goals outside of their perceived treatment domain or available resources; they highlighted the benefits of the tool to facilitate conversation but raised concerns regarding current constraints of the clinic visit. Patients endorsed the utility of such a tool to support agenda setting and preparing for a visit. Clinicians, patients, and community stakeholders reported the tool was useful but identified barriers to implementation that the tool could itself resolve. CONCLUSION A goal elicitation tool for persons with RA and their clinicians was iteratively developed with feedback from multiple stakeholders. The tool can provide a structured way to communicate patient goals within a clinic visit and help overcome reported barriers such as time constraints. Incorporating a structured communication tool to enhance goal communication and foster shared decision making may lead to improved outcomes and higher-quality care in RA.
Collapse
Affiliation(s)
- Julie Kahler
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA
| | | | - Rachel Matsumoto
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA
| | - Danielle ZuZero
- Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | - Jacob Dougherty
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA
| | - Jennifer L. Barton
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, 3710 SW US Veterans Hospital Rd., Portland, OR 97239, USA,Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| |
Collapse
|
9
|
Broekharst DSE, Bloem S, Groenland EAG, van Raaij WF, van Agthoven M. Differences between expert reported and patient reported burden of disease rankings. Sci Rep 2022; 12:895. [PMID: 35042859 PMCID: PMC8766519 DOI: 10.1038/s41598-021-04070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/13/2021] [Indexed: 11/08/2022] Open
Abstract
Many attempted to develop burden of disease rankings for the purpose of resource allocation, priority setting, cost-effectiveness evaluation, and service development in healthcare. As this proved difficult the World Health Organization commissioned expert panels to develop internally consistent burden of disease rankings. Although these rankings provide valuable insight in the biomedical burden of different diseases, they do not yet provide insight in the psychological burden of different diseases experienced and reported by patients on a daily basis. Since expert reported and patient reported burden of disease could differ, deviations between expert reported and patient reported burden of disease rankings are likely. To explore how these rankings differ, it is important to develop patient reported burden of disease rankings and compare these to expert reported burden of disease rankings. In this study patient reported burden of disease rankings were developed by ranking the subjective health experience of patients. To measure subjective health experience an online questionnaire was administered to a large panel of Dutch citizens. The final sample consisted of 58,490 panel members. This final sample contained 36 diseases and was largely representative of the Dutch population. The data were analysed by using reliability tests, descriptive statistics and Spearman rank-order correlation coefficients. This study shows that expert reported and patient reported burden of disease rankings could differ. Burden of cardiovascular diseases ranks low on patient reported burden of disease rankings, while it ranks higher on expert reported burden of disease rankings. Burden of psychiatric diseases and gastrointestinal diseases ranks high on patient reported burden of disease rankings, while it ranks lower on expert reported burden of disease rankings. Burden of pain diseases ranks high on patient reported burden of disease rankings, while it is still overlooked in expert reported burden of disease rankings. This study suggests that it can be beneficial to develop and utilize patient reported burden of disease rankings in addition to the already existing expert reported burden of disease rankings in order to establish a more comprehensive perspective on burden of disease. This could improve decision-making on resource allocation, priority setting, cost-effectiveness evaluation, and service development in healthcare.
Collapse
Affiliation(s)
- Damien S E Broekharst
- Center for Marketing and Supply Chain Management, Nyenrode Business University, Breukelen, The Netherlands.
| | - Sjaak Bloem
- Center for Marketing and Supply Chain Management, Nyenrode Business University, Breukelen, The Netherlands
- Janssen-Cilag B.V., Johnson and Johnson, Breda, The Netherlands
| | - Edward A G Groenland
- Center for Marketing and Supply Chain Management, Nyenrode Business University, Breukelen, The Netherlands
| | - W Fred van Raaij
- Department of Social Psychology, Tilburg University, Tilburg, The Netherlands
| | | |
Collapse
|
10
|
Bergman M, Tundia N, Yang M, Orvis E, Clewell J, Bensimon A. Economic Benefit from Improvements in Quality of Life with Upadacitinib: Comparisons with Tofacitinib and Methotrexate in Patients with Rheumatoid Arthritis. Adv Ther 2021; 38:5649-5661. [PMID: 34636000 PMCID: PMC8572211 DOI: 10.1007/s12325-021-01930-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/21/2021] [Indexed: 01/06/2023]
Abstract
Introduction To compare the economic benefit of upadacitinib combination therapy versus tofacitinib combination therapy and upadacitinib monotherapy versus methotrexate monotherapy from improvements in health-related quality of life (HRQOL) in patients with rheumatoid arthritis (RA). Methods Data were analyzed from two trials of upadacitinib (SELECT-NEXT and SELECT-MONOTHERAPY) and one trial of tofacitinib (ORAL-Standard) that collected HRQOL measurements using the Short Form 36 (SF-36) Health Survey in patients with RA. Direct medical costs per patient per month (PPPM) for patients receiving upadacitinib 15 mg once daily and methotrexate were derived from observed SF-36 Physical (PCS) and Mental Component Summary (MCS) scores in the SELECT trials using a regression algorithm. Direct medical costs PPPM for patients receiving tofacitinib 5 mg twice daily were obtained from a published analysis of SF-36 PCS and MCS scores observed in the ORAL-Standard trial. Short-term (12–14 weeks) and long-term (48 weeks) estimates of direct medical costs PPPM were compared between upadacitinib and tofacitinib and between upadacitinib and methotrexate. Results Over 12 weeks, direct medical costs PPPM were $252 lower (95% CI $72, $446) for upadacitinib-treated patients versus tofacitinib-treated patients. Medical costs PPPM at weeks 24 and 48 and cumulative costs over the entire 48-week period (difference $1759; 95% CI $1162, $2449) were significantly lower for upadacitinib than for tofacitinib. Over 14 weeks, direct medical costs PPPM were $399 lower (95% CI $158, $620) for patients treated with upadacitinib monotherapy compared with those treated with methotrexate alone. Direct medical costs at week 48 and cumulative costs over the entire 48-week period (difference $2044; 95% CI $1221, $2846) were significantly lower for upadacitinib monotherapy compared with methotrexate alone. Conclusion In the short and long term, upadacitinib combination therapy versus tofacitinib combination therapy and upadacitinib monotherapy versus methotrexate monotherapy were associated with significantly lower direct medical costs for patients with RA. Trial Registration ClinicalTrials.gov identifier, NCT02675426, NCT02706951, and NCT00853385. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01930-4.
Collapse
Affiliation(s)
- Martin Bergman
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Min Yang
- Analysis Group, Inc., 111 Huntington Avenue 14th Floor, Boston, MA, 02199, USA
| | - Eli Orvis
- Analysis Group, Inc., 111 Huntington Avenue 14th Floor, Boston, MA, 02199, USA
| | | | - Arielle Bensimon
- Analysis Group, Inc., 111 Huntington Avenue 14th Floor, Boston, MA, 02199, USA.
| |
Collapse
|
11
|
Coates LC, Azevedo VF, Cappelleri JC, Moser J, Eder L, Richette P, Weng MY, Silva RQ, Garg A, Majjhoo A, Griffiths CEM, Young P, Howland S. Exploring the Quality of Communication Between Patients with Psoriatic Arthritis and Physicians: Results of a Global Online Survey. Rheumatol Ther 2021; 8:1741-1758. [PMID: 34570345 PMCID: PMC8572306 DOI: 10.1007/s40744-021-00367-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Effective communication between patients with psoriatic arthritis (PsA) and their physicians is important for optimizing treatment outcomes. We assessed the quality of patient-physician communication in terms of awareness and impact of PsA symptoms, their levels of satisfaction, and their perceptions of communications. METHODS A global online survey was conducted by The Harris Poll in adult patients with PsA and physicians managing patients with PsA in eight countries. Participating physicians were either rheumatologists or dermatologists seeing ≥ 10 and ≥ 5 patients with PsA per month, respectively. Patient and physician groups were unmatched. Patient-physician communication was assessed with 35-60 questions regarding discussion topics during consultations, levels of satisfaction with communication, and specific communication issues. RESULTS A total of 1286 patients with PsA (983 and 303 whose primary treating physician was a rheumatologist or dermatologist, respectively) and 1553 physicians (795 rheumatologists and 758 dermatologists) completed the survey. Regardless of whether they were primarily treated by a rheumatologist or dermatologist, most patients reported a social (84% and 81%, respectively) or work (81% and 80%, respectively) impact of PsA, and a major/moderate negative impact on their physical activity levels (79% and 74%, respectively) or emotional/mental wellbeing (69% and 68%, respectively). Physician responses were generally consistent with this; however, physicians often appeared to under-recognize the extent to which PsA affects patients. Most (≥ 85%) patients and physicians were very/somewhat satisfied with their patient-physician communication, and most (≥ 86%) patients were comfortable raising their concerns/fears with their physician. However, > 40% of patients were identified as being at risk of suboptimal communication. These patients were significantly less likely to report their PsA symptoms even when asked, were less comfortable discussing the impacts of PsA with their physician, and were more likely to experience major/moderate impacts of PsA on their health-related quality of life (HRQoL). CONCLUSIONS Physicians often underestimate the impacts of PsA, compared with patients, and some patients may be at risk of suboptimal communication with their attending physician, which may worsen the HRQoL impacts of PsA. These findings highlight a need for ways to improve communication between patients with PsA and their healthcare providers.
Collapse
Affiliation(s)
- Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | | | - Lihi Eder
- Women's College Research Institute, University of Toronto, Toronto, ON, Canada
| | - Pascal Richette
- Rheumatology Department, Lariboisière Hospital, Lariboisière, University of Paris, Paris, France
| | - Meng-Yu Weng
- Department of Internal Medicine, Division of Allergy, Immunology, and Rheumatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Amit Garg
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Christopher E M Griffiths
- Dermatology Centre, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | | | | |
Collapse
|
12
|
O'Neill KD, Marks KE, Sinicrope PS, Crowson CS, Symons D, Myasoedova E, Davis JM. Importance of Shared Treatment Goal Discussions in Rheumatoid Arthritis-A Cross-Sectional Survey: Patients Report Providers Seldom Discuss Treatment Goals and Outcomes Improve When Goals Are Discussed. ACR Open Rheumatol 2021; 3:870-878. [PMID: 34535987 PMCID: PMC8672176 DOI: 10.1002/acr2.11335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/02/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Treat‐to‐target (T2T) and shared decision‐making are valued features of current guidelines for rheumatoid arthritis (RA) management. Although T2T has demonstrated value for improving RA outcomes, implementation remains inconsistent and lacks standardization and procedures for including patient input. We sought to better understand the impact of shared decisions on T2T and how treatment goal discussions between patients and providers impact RA treatment improvement and satisfaction. Methods An anonymous, web‐based questionnaire was presented to United States residents aged 18 years or older with a self‐reported diagnosis of RA by a medical professional with 28 questions regarding socio‐demographics, RA disease activity (DA), diagnosis, treatments, outcomes, and goals. Analyses included descriptive statistics with χ2 and rank sum tests for comparisons. Results The questionnaire was completed by 907 people (mean age of 58 years; mean 11 years since diagnosis; 90% female). The majority (571; 63%) did not discuss RA treatment goals with providers. Patients engaging in treatment goal discussions with their providers were three times more likely to be satisfied with their treatment plans. Patients discussing treatment goals with their providers were more likely to have improved DA levels and 68% more likely to reach remission. Conclusion A majority of patients with RA report having no treatment goal discussion with their providers; however, these discussions are associated with greater DA improvement and treatment satisfaction. Further research should seek understanding of how shared treatment goal discussions relate to successful RA management and explore the development of practical tools to implement them in regular clinic practice as part of a T2T regimen.
Collapse
Affiliation(s)
| | - Kathryne E Marks
- Rheumatoid Patient Foundation, Lutz, Florida, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Pamela S Sinicrope
- Rheumatoid Patient Foundation, Lutz, Florida, and Mayo Clinic, Rochester, Minnesota
| | | | - Dana Symons
- Rheumatoid Patient Foundation, Lutz, Florida
| | | | | |
Collapse
|
13
|
Nagy G, Roodenrijs NMT, Welsing PMJ, Kedves M, Hamar A, van der Goes MC, Kent A, Bakkers M, Pchelnikova P, Blaas E, Senolt L, Szekanecz Z, Choy EH, Dougados M, Jacobs JW, Geenen R, Bijlsma JW, Zink A, Aletaha D, Schoneveld L, van Riel P, Dumas S, Prior Y, Nikiphorou E, Ferraccioli G, Schett G, Hyrich KL, Mueller-Ladner U, Buch MH, McInnes IB, van der Heijde D, van Laar JM. EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021; 81:20-33. [PMID: 34407926 PMCID: PMC8761998 DOI: 10.1136/annrheumdis-2021-220973] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/23/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA). METHODS An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews addressed clinical questions around diagnostic challenges, and pharmacological and non-pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A-D: A typically consistent level 1 studies and D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0-10: 0 completely disagree and 10 completely agree) of the PtCs were determined by the Task Force members. RESULTS Two overarching principles and 11 PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and non-pharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to level D. The mean LoA with the overarching principles and PtCs was generally high (8.4-9.6). CONCLUSIONS These PtCs for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non-pharmacological therapeutic strategies. High-quality evidence was scarce. A research agenda was created to guide future research.
Collapse
Affiliation(s)
- György Nagy
- Department of Rheumatology & Clinical Immunology, Semmelweis University, Budapest, Hungary .,Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Nadia M T Roodenrijs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Melinda Kedves
- Bács-Kiskun County Hospital, Rheumatology Department, Kecskemét, Hungary
| | - Attila Hamar
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marlies C van der Goes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Rheumatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Alison Kent
- Salisbury Foundation Trust NHS Hospital, Wiltshire, UK
| | - Margot Bakkers
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Polina Pchelnikova
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Etienne Blaas
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ladislav Senolt
- Department of Rheumatology, 1st Faculty of Medicine, Charles University and Institute of Rheumatology, Prague, Czech Republic
| | - Zoltan Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ernest H Choy
- CREATE Centre, Section of Rheumatology, School of Medicine, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Maxime Dougados
- Université de Paris Department of Rheumatology - Hôpital Cochin. Assistance Publique - Hôpitaux de Paris INSERM (U1153) Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Johannes Wg Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Johannes Wj Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Daniel Aletaha
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Leonard Schoneveld
- Department of Rheumatology, Bravis Hospital, Roosendaal, The Netherlands
| | - Piet van Riel
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sophie Dumas
- Department of Pharmacy, Marin Hospital, Asisstance Publique-Hopitaux de Paris, Hendaye, France
| | - Yeliz Prior
- School of Health and Society, Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK.,Rheumatology Department, King's College Hospital, London, UK
| | | | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Kimme L Hyrich
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Maya H Buch
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
14
|
Gómez-Galicia DL, Aguilar-Castillo J, García-García C, Moctezuma-Rios JF, Álvarez-Hernández E, Medrano-Ramírez G, Casasola-Vargas J, Xibillé-Friedmann DX, Pelaez-Ballestas I, Montiel-Hernández JL. Qualitative validation of audiovisual educational material for use on rheumatoid arthritis patients. Rheumatol Int 2021; 42:2049-2059. [PMID: 34146129 DOI: 10.1007/s00296-021-04921-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
Medication compliance is critical to achieve therapeutic efficacy in patients with rheumatoid arthritis; however, among other factors, low patient-health literacy plays a negative role. Therefore, the development and validation of audiovisual educational material with the participation of health specialists and patients could lead to an improved level of compliance with treatment, while favoring its acceptance. To design and validate audiovisual educational material generated by a multidisciplinary and participative group of patients and health specialists. This study was carried out using a sequential methodology, including qualitative and quantitative techniques: (1) a non-participative observational study with patients and a non-systematic literature search were performed to identify conceptual topics. (2) Pilot videos were qualitatively assessed by patients and health specialists (focus groups and expert committees). (3) Improved versions of seven videos were quantitatively evaluated by patients and specialists following qualitative criteria of attraction, understanding, involvement, acceptance and induction of action. 74 patients with RA, 10 rheumatologists, 4 pharmacists and 2 medical anthropologists participated in the different phases of validation. A total of seven videos lasting 3 min each were generated, incorporating the most relevant suggestions by patients and healthcare professionals. The final version of the videos led to a mean compliance of 96.04 ± 5.2%, according to a representative group of patients and a mean 89.6 ± 9.4%, according to health professionals. With the participation of both patients and health specialists, seven audiovisual educational video recordings were developed and validated, reaching high levels of compliance in accordance with international criteria.
Collapse
Affiliation(s)
- Diana-Lizbeth Gómez-Galicia
- Laboratory of Pharmaceutical Epidemiology, Facultad de Farmacia, Universidad Autónoma del Estado de Morelos, Cuernavaca, México
| | - Joana Aguilar-Castillo
- Laboratory of Pharmaceutical Epidemiology, Facultad de Farmacia, Universidad Autónoma del Estado de Morelos, Cuernavaca, México
| | - Conrado García-García
- Rheumatology Unit, Hospital General de México "Dr. Eduardo Liceaga", México city, México
| | | | | | | | - Julio Casasola-Vargas
- Rheumatology Unit, Hospital General de México "Dr. Eduardo Liceaga", México city, México
| | | | | | - José-Luis Montiel-Hernández
- Laboratory of Cytokines and Autoimmunity, Facultad de Farmacia, Universidad Autónoma del Estado de Morelos (UAEM), Av. Universidad 1001 col. Chamilpa, C.P. 62209, Cuernavaca, Morelos, México.
| |
Collapse
|
15
|
Cohen S, Wells AF, Curtis JR, Dhar R, Mellors T, Zhang L, Withers JB, Jones A, Ghiassian SD, Wang M, Connolly-Strong E, Rapisardo S, Gatalica Z, Pappas DA, Kremer JM, Saleh A, Akmaev VR. A Molecular Signature Response Classifier to Predict Inadequate Response to Tumor Necrosis Factor-α Inhibitors: The NETWORK-004 Prospective Observational Study. Rheumatol Ther 2021; 8:1159-76. [PMID: 34148193 DOI: 10.1007/s40744-021-00330-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/03/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Timely matching of patients to beneficial targeted therapy is an unmet need in rheumatoid arthritis (RA). A molecular signature response classifier (MSRC) that predicts which patients with RA are unlikely to respond to tumor necrosis factor-α inhibitor (TNFi) therapy would have wide clinical utility. Methods The protein–protein interaction map specific to the rheumatoid arthritis pathophysiology and gene expression data in blood patient samples was used to discover a molecular signature of non-response to TNFi therapy. Inadequate response predictions were validated in blood samples from the CERTAIN cohort and a multicenter blinded prospective observational clinical study (NETWORK-004) among 391 targeted therapy-naïve and 113 TNFi-exposed patient samples. The primary endpoint evaluated the ability of the MSRC to identify patients who inadequately responded to TNFi therapy at 6 months according to ACR50. Additional endpoints evaluated the prediction of inadequate response at 3 and 6 months by ACR70, DAS28-CRP, and CDAI. Results The 23-feature molecular signature considers pathways upstream and downstream of TNFα involvement in RA pathophysiology. Predictive performance was consistent between the CERTAIN cohort and NETWORK-004 study. The NETWORK-004 study met primary and secondary endpoints. A molecular signature of non-response was detected in 45% of targeted therapy-naïve patients. The MSRC had an area under the curve (AUC) of 0.64 and patients were unlikely to adequately respond to TNFi therapy according to ACR50 at 6 months with an odds ratio of 4.1 (95% confidence interval 2.0–8.3, p value 0.0001). Odds ratios (3.4–8.8) were significant (p value < 0.01) for additional endpoints at 3 and 6 months, with AUC values up to 0.74. Among TNFi-exposed patients, the MSRC had an AUC of up to 0.83 and was associated with significant odds ratios of 3.3–26.6 by ACR, DAS28-CRP, and CDAI metrics. Conclusion The MSRC stratifies patients according to likelihood of inadequate response to TNFi therapy and provides patient-specific data to guide therapy choice in RA for targeted therapy-naïve and TNFi-exposed patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00330-y. A blood-based molecular signature response classifier (MSRC) integrating next-generation RNA sequencing data with clinical features predicts the likelihood that a patient with rheumatoid arthritis will have an inadequate response to TNFi therapy. Treatment selection guided by test results, with likely inadequate responders appropriately redirected to a different therapy, could improve response rates to TNFi therapies, generate healthcare cost savings, and increase rheumatologists’ confidence in prescribing decisions and altered treatment choices. The MSRC described in this study predicts the likelihood of inadequate response to TNFi therapies among targeted therapy-naïve and TNFi-exposed patients in a multicenter, 24-week blinded prospective clinical study: NETWORK-004. Patients with a molecular signature of non-response are less likely to have an adequate response to TNFi therapies than those patients lacking the signature according to ACR50, ACR70, CDAI, and DAS28-CRP with significant odds ratios of 3.4–8.8 for targeted therapy-naïve patients and 3.3–26.6 for TNFi-exposed patients. This MSRC provides a solution to the long-standing need for precision medicine tools to predict drug response in rheumatoid arthritis—a heterogeneous and progressive disease with an abundance of therapeutic options. These data validate the performance of the MSRC in a blinded prospective clinical study of targeted therapy-naïve and TNFi therapy-exposed patients.
Collapse
|
16
|
Allen JA, Butler L, Levine T, Haudrich A. A Global Survey of Disease Burden in Patients Who Carry a Diagnosis of Chronic Inflammatory Demyelinating Polyneuropathy. Adv Ther 2021; 38:316-328. [PMID: 33113101 PMCID: PMC7854453 DOI: 10.1007/s12325-020-01540-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/15/2020] [Indexed: 01/24/2023]
Abstract
Introduction The extent to which work productivity, emotional well-being, social interactions, and family life are impacted in patients who self-identify as having chronic inflammatory demyelinating polyneuropathy (CIDP) is not well characterized. Methods Data from an online survey of 595 individuals with self-reported CIDP, recruited by the Guillain–Barré syndrome (GBS)/CIDP Foundation, were used to assess disease and treatment burden. A total of 37% of patients were classified as “likely”, 34% as “somewhat likely”, and 28% as “unlikely” CIDP. Results Of ten symptoms that patients with CIDP may experience, each symptom was experienced by 77–94% of “likely”, 79–96% of “somewhat likely”, and 66–91% of “unlikely” patients. In “likely” CIDP patients 44% stopped working because of their symptoms and 24% moved to a new home. The most common treatments were intravenous immunoglobulin (IVIg) infusion and corticosteroids. IVIg was associated with venous access issues and work/school absenteeism. Conclusions CIDP diagnostic confirmation was not performed in any of the survey respondents. Our results do not add any knowledge on the diagnosis or treatment of CIDP. Our findings do provide insight into the symptoms that patients that think they have CIDP or have been told they have CIDP experience, explores how patients that are labeled as having CIDP view treatment expectations, and highlights how these symptoms affect home and work life. We hope that the findings are constructively used to get patients the services they need to improve quality of life, maintain employment, and ensure a safe home environment regardless of diagnostic accuracy.
Collapse
|
17
|
Roodenrijs NMT, Hamar A, Kedves M, Nagy G, van Laar JM, van der Heijde D, Welsing PMJ. Pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis. RMD Open 2021; 7:e001512. [PMID: 33419871 PMCID: PMC7798678 DOI: 10.1136/rmdopen-2020-001512] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To summarise, by a systematic literature review (SLR), the evidence regarding pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis (D2T RA), informing the EULAR recommendations for the management of D2T RA. METHODS PubMed, Embase and Cochrane databases were searched up to December 2019. Relevant papers were selected and appraised. RESULTS Two hundred seven (207) papers studied therapeutic strategies. Limited evidence was found on effective and safe disease-modifying antirheumatic drugs (DMARDs) in patients with comorbidities and other contraindications that limit DMARD options (patients with obesity, hepatitis B and C, risk of venous thromboembolisms, pregnancy and lactation). In patients who previously failed biological (b-)DMARDs, all currently used b/targeted synthetic (ts-)DMARDs were found to be more effective than placebo. In patients who previously failed a tumour necrosis factor inhibitor (TNFi), there was a tendency of non-TNFi bDMARDs to be more effective than TNFis. Generally, effectiveness decreased in patients who previously failed a higher number of bDMARDs. Additionally, exercise, psychological, educational and self-management interventions were found to improve non-inflammatory complaints (mainly functional disability, pain, fatigue), education to improve goal setting, and self-management programmes, educational and psychological interventions to improve self-management.The identified evidence had several limitations: (1) no studies were found in patients with D2T RA specifically, (2) heterogeneous outcome criteria were used and (3) most studies had a moderate or high risk of bias. CONCLUSIONS This SLR underscores the scarcity of high-quality evidence on the pharmacological and non-pharmacological treatment of patients with D2T RA. Effectiveness of b/tsDMARDs decreased in RA patients who had failed a higher number of bDMARDs and a subsequent b/tsDMARD of a previously not targeted mechanism of action was somewhat more effective. Additionally, a beneficial effect of non-pharmacological interventions was found for improvement of non-inflammatory complaints, goal setting and self-management.
Collapse
Affiliation(s)
- Nadia M T Roodenrijs
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Attila Hamar
- Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Melinda Kedves
- Rheumatology, Bacs-Kiskun Megyei Korhaz, Kecskemet, Hungary
| | - György Nagy
- Genetics, Cell- and Immunobiology & Rheumatology & Clinical Rheumatology, Semmelweis University, Budapest, Hungary
| | - Jacob M van Laar
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Paco M J Welsing
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
18
|
Omair MA, Erdogan A, Tietz N, Alten R. Physical and Emotional Burden of Rheumatoid Arthritis in Saudi Arabia: An Exploratory Cross-Sectional Study. Open Access Rheumatol 2020; 12:337-345. [PMID: 33380844 PMCID: PMC7769156 DOI: 10.2147/oarrr.s284734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/09/2020] [Indexed: 01/01/2023] Open
Abstract
Purpose The aim of this study was to better understand the physical and emotional impacts of rheumatoid arthritis (RA) on the lives of patients in Saudi Arabia, and to determine whether there are any discrepancies between how healthcare providers (HCPs) perceive the feelings of patients with RA and how patients actually feel. Patients and Methods An online survey of adults with RA and HCPs was conducted in Saudi Arabia between January and June 2018. The survey used closed-ended questions with nominal and interval scales to cover relationships with others, ability to work and career progression, ability to perform normal activities, and aspirations for the future. Results In total, 85 patients and 24 HCPs were surveyed. Patients were more likely than HCPs to feel that the people around them understood the emotional and physical impacts of RA (emotional impact understood: 67% of patients vs 42% of HCPs; physical impact understood: 61% vs 38%, respectively). Additionally, a larger proportion of younger (aged <40 years) than older patients (aged 40-59 and ≥60 years) felt that these impacts were not understood by others. For patients, the greatest barrier to working was difficulty using hands (52% vs 41% of HCPs), whereas HCPs considered pain the greatest barrier (50% vs 38% of patients). Both patients (59%) and HCPs (81%) considered pain to be a common barrier to undertaking everyday activities. Regarding future aspirations, 40% of patients wished to accept their RA despite the barriers it caused. Conclusion Discrepancies between how HCPs perceived the feelings of patients with RA and how patients actually felt suggest that HCP-patient communication could be improved. This is the first study of its kind in Saudi Arabia and should help increase awareness of the difficulties and concerns of patients with RA in the Arabic world.
Collapse
Affiliation(s)
- Mohammed A Omair
- Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alper Erdogan
- Medical Affairs Department, Eli Lilly and Company, Riyadh, Saudi Arabia
| | | | - Rieke Alten
- Schlosspark-Klinik University Medicine, Berlin, Germany
| |
Collapse
|
19
|
Dey M, Zhao SS. Google search data as a novel adjunct to patient and public involvement in rheumatology research. Rheumatol Int 2021; 41:771-9. [PMID: 33074346 DOI: 10.1007/s00296-020-04723-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Abstract
Patient and public involvement is essential in the design and implementation of research studies to ensure research remains relevant and in line with public priorities. Public views on a given area of research may be sought via platforms such as focus groups or surveys. Here, we present the use of an openly available Google search data query tool, which may be used alongside traditional forms of patient and public involvement in research to highlight public perceptions and priorities. We used an online search query tool (“AnswerThePublic.com”) to explore public Google searches relating to “arthritis,” and an exemplar rheumatic disease, “rheumatoid arthritis.” The most common searches relating to these diseases included quality of life, treatment, prognosis, as well as impacts on life, including work. However, they also reveal concerns that may be more difficult to elicit in face-to-face focus groups, such as questions on alcohol consumption in arthritis, and impacts on mental health. Using public search engine data in research, alongside the important traditional methods of patient and public involvement, is a cost-effective and time-efficient method of gauging public views and concerns on a given topic. It may facilitate broad scoping searches of public priorities and help to guide future research questions.
Collapse
|
20
|
Sun J, Dai S, Zhang L, Feng Y, Yu X, Zhang Z. Investigating the safety and compliance of using csDMARDs in rheumatoid arthritis treatment through face-to-face interviews: a cross-sectional study in China. Clin Rheumatol 2020; 40:1789-1798. [PMID: 33058034 PMCID: PMC8102276 DOI: 10.1007/s10067-020-05458-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/06/2020] [Accepted: 10/08/2020] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA) significantly impacts the health of Chinese patients. Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) are used as the standard treatment for patients with RA. However, Chinese patients with RA have reported poor compliance with csDMARDs. This study aims to better understand the safety and compliance of using csDMARDs in RA treatment. Face-to-face interviews were conducted by questionnaires on safety and compliance of csDMARDs in 400 patients with RA and 100 rheumatologists from 13 cities in China. Rheumatologists were from Tier 3 Class A hospitals with independent rheumatology departments, who admitted more than 30 patients with RA per week. All patients were diagnosed for > 3 months before the survey and had been treated with csDMARDs for > 3 months. The incidence of adverse events (AEs) that attributed to csDMARDs estimated by rheumatologists was lower than that reported by patients for all four prescribed csDMARDs. Also, types of common AEs in rheumatologist’s perception differed from those in the patient’s report. Only 86% (116/135) of patients claimed they notified their rheumatologist about AEs, and 40.8% (150/368) of patients did not strictly adhere to their prescribed treatment. Reasons why patients were not compliant with their treatment, other than AEs, included symptoms being less severe, travel, and busy working life/business trips. This study revealed gaps in perceptions of csDMARDs-related AEs and medication adherence between rheumatologists and patients. These findings suggested adequate doctor-patient communications, and considerations of multiple real-world situations may improve adherence in the treatment of RA patients.Key Points • This study identified gaps in rheumatologists’ perception of the prevalence and type of AEs experienced by their patients, which could potentially help them improve their patients’ compliance with treatment. |
Collapse
Affiliation(s)
- Jiaying Sun
- Department of Rheumatology and Immunology, First Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Siming Dai
- Department of Rheumatology and Immunology, First Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Ling Zhang
- Shanghai Roche Pharmaceuticals Ltd., Shanghai, 201203, China
| | - Yajing Feng
- Shanghai Roche Pharmaceuticals Ltd., Shanghai, 201203, China
| | - Xin Yu
- Shanghai Roche Pharmaceuticals Ltd., Shanghai, 201203, China
| | - Zhiyi Zhang
- Department of Rheumatology and Immunology, First Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China.
| |
Collapse
|
21
|
Favalli EG. Understanding the Role of Interleukin-6 (IL-6) in the Joint and Beyond: A Comprehensive Review of IL-6 Inhibition for the Management of Rheumatoid Arthritis. Rheumatol Ther 2020; 7:473-516. [PMID: 32734482 PMCID: PMC7410942 DOI: 10.1007/s40744-020-00219-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Indexed: 12/17/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, debilitating autoimmune disorder involving inflammation and progressive destruction of the joints, affecting up to 1% of the population. The majority of patients with RA have one or more comorbid conditions, the most common being cardiovascular disease, osteoporosis, and depression, the presence of which are associated with poorer clinical outcomes and lower health-related quality of life. RA pathogenesis is driven by a complex network of proinflammatory cells and cytokines, and of these, interleukin-6 (IL-6) plays a key role in the chronic inflammation associated with RA. Through cell signaling that can be initiated by both membrane-bound and soluble forms of its receptor, IL-6 acts both locally to promote joint inflammation and destruction, and in the circulation to mediate extra-articular manifestations of RA, including pain, fatigue, morning stiffness, anemia, and weight loss. This narrative review describes the role of IL-6 in the pathogenesis of RA, its comorbidities, and extra-articular systemic manifestations, and examines the effects of the IL-6 receptor inhibitors sarilumab and tocilizumab on clinical endpoints of RA, patient-reported outcomes, and common comorbidities and extra-articular manifestations.
Collapse
Affiliation(s)
- Ennio G Favalli
- Department of Rheumatology, ASST Gaetano Pini-CTO Institute, University of Milan, Milan, Italy.
| |
Collapse
|
22
|
Pile K, Norager R, Skillecorn M, Gibson KA, Elderton S, Favorito W, Li Z, Mu R, Nakahara H, Kishimoto M, Hirata S, Kaneko Y, Lau CS, Tam LS, Chen YH, Chen P, Wahking B, Furtner D. Elevating the role of carers in rheumatoid arthritis management in the Asia-Pacific region. Int J Rheum Dis 2020; 23:898-910. [PMID: 32613764 PMCID: PMC7496573 DOI: 10.1111/1756-185x.13893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/01/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022]
Abstract
Aim Carers may offer valuable insight into the true health status of patients with rheumatoid arthritis (RA). This multinational, multi‐stakeholder, exploratory study in Australia, China and Japan aimed to enrich our understanding of the role and potential impact of carers on RA management. Method This study used a 2‐phase sequential mixed methods approach involving 3 key stakeholder groups: rheumatologists, RA patients and carers. The first phase involved an in‐depth qualitative exploratory survey (n = 30), which informed the development of the subsequent quantitative validation survey (n = 908). In both phases, patients and carers provided self‐assessments of disease and support parameters. Results In the qualitative phase, patients usually understated the amount of physical support required, compared to carers. Rheumatologists underestimated the amount of physical and emotional care required, compared to carers and patients; however, in the quantitative phase, rheumatologists overestimated the level of support provided by carers. Levels of support provided by carers increased as disease severity increased. Active participation of carers in clinical consultations and treatment decision‐making was deemed important by 55% of all patients and 82% of all carers. All stakeholders believed carers’ insights into the physical and emotional conditions of patients were useful and should be considered in clinical decision‐making. Over 95% of rheumatologists reported soliciting input from the carer. Conclusion Carers provide valuable input that can give clinicians greater insight into the patients’ physical and emotional states, and treatment adherence. Development of standardized carer‐reported outcomes that correlate with patient‐reported outcomes and clinical parameters will ensure clinical meaningfulness and external validity.
Collapse
Affiliation(s)
- Kevin Pile
- Department of Medicine, Western Sydney University, Sydney, NSW, Australia.,Campbelltown Hospital, South West Sydney Local Health District, Sydney, NSW, Australia
| | | | | | - Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Sydney, Australia
| | | | | | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Rong Mu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Hideko Nakahara
- Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Chak-Sing Lau
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pearly Chen
- Johnson & Johnson Pte Ltd, Singapore, Singapore
| | | | | |
Collapse
|
23
|
Kaneko Y, Sato M, Cai Z, Sato M. Assessment of discordance of treatment satisfaction between patients with rheumatoid arthritis in low disease activity or in remission and their treating physicians: A cross-sectional survey. Mod Rheumatol 2020; 31:326-333. [PMID: 32475196 DOI: 10.1080/14397595.2020.1775945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess discordance in overall treatment satisfaction between patients with rheumatoid arthritis (RA) and their physicians. METHODS This was a multicenter, cross-sectional, observational study of patients with RA (in low disease activity or remission) and their board-certified treating physicians in Japan; 202 patient-physician pairs were analyzed. Treatment satisfaction and perceptions were assessed using a structured questionnaire. RESULTS Using a two-level ('satisfied' or 'unsatisfied') assessment of satisfaction, 195 patients (96.5%) and 190 physicians (94.1%) answered 'satisfied' with a high level of concordance (184 pairs, 91.1%). Using a four-level assessment, the ratio of 'satisfied' to 'somewhat satisfied' was higher in patients (66.3%/30.2%) than physicians (43.6%/50.5%). Satisfaction with treatment outcomes (e.g. joint conditions, subjective symptoms) was generally high in patients and physicians; relatively less satisfaction was reported for medication cost, especially among patients. Shared treatment decision-making was reported in ≥96% of patient-physician pairs. The most common 'most important' treatment target differed between patients ('Have a social life without worrying about RA') and physicians ('Prevent joint damage, deformity, and joint swelling'). CONCLUSIONS Treatment satisfaction and concordance were high between patients in low activity/remission and physicians. Some differences between patients and physicians were reported in satisfaction for specific treatment outcomes and important treatment targets.
Collapse
Affiliation(s)
- Yuko Kaneko
- Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | | | | | | |
Collapse
|
24
|
Abstract
PURPOSE OF REVIEW Implementing shared decision-making (SDM) is a top international priority to improve care for persons living with rheumatoid arthritis. Using SDM tools, such as decision aids improve patients' knowledge and support communication with their clinicians on treatment benefits and risks. Despite calls for SDM in treat-to-target, studies demonstrating effective SDM strategies in rheumatology clinical practice are scarce. Our objective was to identify recent and relevant literature on SDM in rheumatoid arthritis. RECENT FINDINGS We found a burgeoning literature on SDM in rheumatoid arthritis that tackles issues of implementation. Studies have evaluated the SDM process within clinical consultations and found that uptake is suboptimal. Trials of newly developed patient decision aids follow high methodological standards, but large-scale implementation is lacking. Innovative SDM strategies, such as shared goals and preference phenotypes may improve implementation of treat-to-target approach. Research and patient engagement are standardizing measures of SDM for clinical uses. SUMMARY Uptake of SDM in rheumatoid arthritis holds promise in wider clinicians' and patients' awareness, availability of decision aids, and broader treat-to-target implementation strategies, such as the learning collaborative. Focused attention is needed on facilitating SDM among diverse populations and those at risk of poorer outcomes and barriers to communication.
Collapse
Affiliation(s)
- Jennifer L. Barton
- Oregon Health & Science University, VA Portland Health Care System, Portland (Oregon), United States
| | - Simon Décary
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL), Quebec (Quebec), Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec (Quebec), Canada
| |
Collapse
|
25
|
Taylor PC, Betteridge N, Brown TM, Woolcott J, Kivitz AJ, Zerbini C, Whalley D, Olayinka-Amao O, Chen C, Dahl P, Ponce de Leon D, Gruben D, Fallon L. Treatment Mode Preferences in Rheumatoid Arthritis: Moving Toward Shared Decision-Making. Patient Prefer Adherence 2020; 14:119-131. [PMID: 32021123 PMCID: PMC6980841 DOI: 10.2147/ppa.s220714] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/03/2019] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Current knowledge of the reasons for patients' preference for rheumatoid arthritis (RA) treatment modes is limited. This study was designed to identify preferences for four treatment modes, and to obtain in-depth information on the reasons for these preferences. PATIENTS AND METHODS In this multi-national, cross-sectional, qualitative study, in-depth interviews were conducted with adult patients with RA in the United States, France, Germany, Italy, Spain, Switzerland, the United Kingdom, and Brazil. Patients' strength of preference was evaluated using a 100-point allocation task (0-100; 100=strongest) across four treatment modes: oral, self-injection, clinic-injection, and infusion. Qualitative descriptive analysis methods were used to identify, characterize, and summarize patterns found in the interview data relating to reasons for these preferences. RESULTS 100 patients were interviewed (female, 75.0%; mean age, 53.9 years; mean 11.6 years since diagnosis). Among the four treatment modes, oral administration was allocated the highest mean (standard deviation) preference points (47.3 [33.1]) and was ranked first choice by the greatest percentage of patients (57.0%), followed by self-injection (29.7 [27.7]; 29.0%), infusion (15.4 [24.6]; 16.0%), and clinic-injection (7.5 [14.1]; 2.0%). Overall, 56.0% of patients had a "strong" first-choice preference (ie, point allocation ≥70); most of these patients chose oral (62.5%) vs self-injection (23.2%), infusion (10.7%), or clinic-injection (3.6%). Speed and/or ease of administration were the most commonly reported reasons for patients choosing oral (52.6%) or self-injection (55.2%). The most common reasons for patients not choosing oral or self-injection were not wanting to take another pill (37.2%) and avoiding pain due to needles (46.5%), respectively. CONCLUSION These data report factors important to patients regarding preferences for RA treatment modes. Patients may benefit from discussions with their healthcare professionals and/or patient support groups, regarding RA treatment modes, to facilitate shared decision-making.
Collapse
Affiliation(s)
- Peter C Taylor
- Botnar Research Centre, University of Oxford, Oxford, UK
- Correspondence: Peter C Taylor Botnar Research Centre, University of Oxford, Windmill Road, Headington, OxfordOX3 7LD, UKTel +441865 227323 Email
| | | | - T Michelle Brown
- Patient-Centered Outcomes Assessment Group, RTI Health Solutions, Research Triangle Park, NC, USA
| | - John Woolcott
- Patient and Health Impact, Health Economics and Outcomes Research, Pfizer Inc, Collegeville, PA, USA
| | - Alan J Kivitz
- Altoona Center for Clinical Research, Duncansville, PA, USA
| | - Cristiano Zerbini
- Department of Rheumatology, Centro Paulista De Investigação Clinica, São Paulo, Brazil
| | - Diane Whalley
- Patient-Centered Outcomes Assessment Group, RTI Health Solutions, Manchester, UK
| | - Oyebimpe Olayinka-Amao
- Patient-Centered Outcomes Assessment Group, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Connie Chen
- Xeljanz, Rheumatology, Inflammation & Immunology Medical Affairs, Pfizer Inc, New York, NY, USA
| | - Palle Dahl
- Medical Affairs, International Developed Markets, Inflammation & Immunology, Pfizer Inc, Ballerup, Denmark
| | | | - David Gruben
- Statistical Research and Data Science Center, Pfizer Inc, Groton, CT, USA
| | - Lara Fallon
- Global Medical Affairs, Pfizer Inc, Montreal, QC, Canada
| |
Collapse
|
26
|
Batko B, Batko K, Krzanowski M, Żuber Z. Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis. J Clin Med 2019; 8:E1416. [PMID: 31500394 PMCID: PMC6780913 DOI: 10.3390/jcm8091416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/26/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
Principles of treat-to-target (T2T) have been widely adopted in both multinational and regional guidelines for rheumatoid arthritis (RA). Several questionnaire studies among physicians and real-world data have suggested that an evidence-practice gap exists in RA management. Investigating physician adherence to T2T, which requires a process measure, is difficult. Different practice patterns among physicians are observed, while adherence to protocolized treatment declines over time. Rheumatologist awareness, agreement, and claims of adherence to T2T guidelines are not always consistent with medical records. Comorbidities, a difficult disease course, communication barriers, and individual preferences may hinder an intensive, proactive treatment stance. Interpreting deviations from protocolized treatment/T2T guidelines requires sufficient clinical context, though higher adherence seems to improve clinical outcomes. Nonmedical constraints in routine care may consist of barriers in healthcare structure and socioeconomic factors. Therefore, strategies to improve the institution of T2T should be tailored to local healthcare. Educational interventions to improve T2T adherence among physicians may show a moderate, although beneficial effect. Meanwhile, a proportion of patients with inadequately controlled RA exists, while management decisions may not be in accordance with T2T. Physicians tend to be aware of current guidelines, but their institution in routine practice seems challenging, which warrants attention and further study.
Collapse
Affiliation(s)
- Bogdan Batko
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Gustawa Herlinga-Grudźińskiego 1 St, 30-705 Cracow, Poland.
- Department of Rheumatology, J. Dietl Specialist Hospital, Skarbowa 1 St, 31-121 Cracow, Poland.
| | - Krzysztof Batko
- Chair and Head of Nephrology, Jagiellonian University Medical College, Kopernika St 15c, 31-501 Cracow, Poland.
| | - Marcin Krzanowski
- Chair and Head of Nephrology, Jagiellonian University Medical College, Kopernika St 15c, 31-501 Cracow, Poland.
| | - Zbigniew Żuber
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Gustawa Herlinga-Grudźińskiego 1 St, 30-705 Cracow, Poland.
- Ward for Older Children with Neurology and Rheumatology Subdivision, St. Louis Regional Specialised Children's Hospital, 31-503 Cracow, Poland.
| |
Collapse
|
27
|
Affiliation(s)
- Susan M Goodman
- Hospital for Special Surgery, Weill-Cornell Medical School, Department of Medicine, New York, New York, USA.
| | - Peter K Sculco
- Hospital for Special Surgery, Weill-Cornell Medical School, Department of Medicine, New York, New York, USA
| |
Collapse
|
28
|
Cook NS, Cave J, Holtorf AP. Patient Preference Studies During Early Drug Development: Aligning Stakeholders to Ensure Development Plans Meet Patient Needs. Front Med (Lausanne) 2019; 6:82. [PMID: 31069227 PMCID: PMC6491461 DOI: 10.3389/fmed.2019.00082] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/02/2019] [Indexed: 12/11/2022] Open
Abstract
Although patient preferences have been studied broadly for marketed products or around the time of submission to authorities and launch, patient preference studies have rarely been used during the early drug development phases. In this paper, we formulate three hypotheses supporting the use of patient preference studies in early product development: (1) integration of the patient perspective into the development process from phase 1 onwards will result in healthcare solutions with outcomes that best address patients' needs; (2) a structured process to build patient-based evidence involving partnerships between patients and other key stakeholders will improve alignment of development activities with the needs of patients; (3) quantitative patient preference research built on robust qualitative insights is necessary to strengthen development decisions in the interests of patients. To illustrate such a structured process, we describe qualitative insights research (social media analysis and online bulletin boards) and quantitative patient preference studies in dry eye disease and non-alcoholic steatohepatitis conducted during early product development by a pharmaceutical company to generate patient-based evidence. The outputs from such early patient preference studies are being used to inform patient reported outcome strategies, clinical development strategies, product design and delivery features, and form the basis for early dialog with regulators, health technology assessment (HTA) bodies and payers to ensure focus and alignment on patient-relevant endpoints. Furthermore, to discuss and theoretically substantiate our hypotheses, we review how different groups and organizations are working to embrace fully the patient perspective in product development and healthcare decision-making. The hypotheses are commensurate with the general trend toward patient-centered healthcare and the activities initiated by regulators, HTA agencies, and patient organizations. We advocate that all healthcare players should actively contribute to aligning on best practices concerning choice of methodologies and engage in multi-stakeholder dialog along the entire product development chain, to realize health technologies that best meet the needs of patients.
Collapse
Affiliation(s)
| | - Julie Cave
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | | |
Collapse
|
29
|
Mattukat K, Boehm P, Raberger K, Schaefer C, Keyszer G, Mau W. How Much Information and Participation Do Patients with Inflammatory Rheumatic Diseases Prefer in Interaction with Physicians? Results of a Participatory Research Project. Patient Prefer Adherence 2019; 13:2145-2158. [PMID: 31908422 PMCID: PMC6927260 DOI: 10.2147/ppa.s209346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/25/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Patient preferences for information and participation in medical decision-making are important prerequisites to realize a shared decision between patients and physicians. This paper aims at exploring these preferences in German patients with inflammatory rheumatic diseases and at identifying relevant determinants of these preferences. METHODS In a cross-sectional survey, adult patients with rheumatoid arthritis (RA), spondyloarthritis (SA) or different connective tissue diseases (CTS) filled out a questionnaire. Data were collected via a written questionnaire (1) sent to members of a regional self-help group or (2) handed out to patients at their rheumatologist's appointment, and (3) via an online questionnaire available nationwide. Measurements included information and participation preferences (Autonomy Preference Index; API: 0-100), as well as health-related and sociodemographic variables. Analyses included ANOVAs (group differences) and multiple regression analyses (determinants of preferences). To ensure the analysis was patient-centered we involved a trained representative of the German League Against Rheumatism as a research partner. RESULTS 1616 patients returned questionnaires [44% response, 79% female, mean age 54 years, diagnoses 63% RA, 28% SA, 19% CTS]. Participants reported a concurring major preference for information but vastly different preferences for participation. A greater preference for participation was associated with female sex, younger age, higher household income, and self-help group membership. Conversely, a lower preference for participation was linked to blue-collar workers, retirement, higher confidence in the rheumatologist, and poorer health literacy. CONCLUSION Whereas patients consistently welcome comprehensive information about their disease and its different treatment options, not all patients wish to be involved in therapeutic decisions. Especially older patients with lower education status and lower health literacy, but higher confidence in their rheumatologist tend to leave the decisions rather to the physician. Different preferences should be considered in the doctor-patient communication.
Collapse
Affiliation(s)
- Kerstin Mattukat
- Institute of Rehabilitation Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Correspondence: Kerstin Mattukat Institute of Rehabilitation Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Street 8, Halle (Saale)06112, GermanyTel +49 345 557-7646Fax +49 345 557-4206 Email
| | - Peter Boehm
- Federal Association of the German League Against Rheumatism, Bonn, Germany
| | - Katja Raberger
- Institute of Rehabilitation Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christoph Schaefer
- Clinic for Internal Medicine II, Department of Internal Medicine, University Hospital Halle, Halle (Saale), Germany
| | - Gernot Keyszer
- Clinic for Internal Medicine II, Department of Internal Medicine, University Hospital Halle, Halle (Saale), Germany
| | - Wilfried Mau
- Institute of Rehabilitation Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|