Owensby Justin K, Chen Lang, O'Beirne Ronan, Ruderman Eric M, Harrold Leslie R, Melnick Joshua A, Safford Monika M, Curtis Jeffrey R, Danila Maria I
University of Alabama at Birmingham.
Northwestern University, Evanston, Illinois.
Arthritis Care Res (Hoboken). 2020 Jul;72(7):933-941. doi: 10.1002/acr.23907.
To identify and prioritize patient- and rheumatologist-perceived barriers to achieving disease control.
Patients with rheumatoid arthritis (RA) and rheumatologists from the Corrona registry were invited by e-mail to participate in nominal groups. Two separate lists of barriers were created, 1 from RA patient-only nominal groups and the other from rheumatologist-only nominal groups, and barriers were sorted into themes. Next, using an online survey, a random sample of RA patients from the Corrona registry were asked to rank their top 3 barriers to achieving disease control.
Four nominal groups totaling 37 RA patients identified patient barriers to achieving control of RA activity that were classified into 17 themes. Three nominal groups totaling 25 rheumatologists identified barriers that were classified into 11 themes. The financial aspects of RA care ranked first for both types of nominal groups, while medication risk aversion ranked second among the perceived barriers of the physician nominal group and third among those of the RA patient nominal group. Among the 450 RA patients surveyed, 77% considered RA a top health priority, and 51% reported being aware of the treat-to-target strategy for RA care; the 3 most important patient-perceived challenges to achieving disease control were RA prognosis uncertainty, medication risk aversion, and the financial/administrative burden associated with RA care.
There are common, potentially modifiable, patient- and rheumatologist-reported barriers to achieving RA disease control, including perceived medication risk aversion, suboptimal treatment adherence, and suboptimal patient-physician communication regarding the benefits of tight control of disease activity in RA. Addressing these obstacles may improve adherence to goal-directed RA care.
识别并确定患者和风湿病专家所感知到的影响疾病控制的障碍，并按优先级排序。
通过电子邮件邀请来自Corrona注册库的类风湿关节炎（RA）患者和风湿病专家参加名义小组。创建了两个单独的障碍列表，一个来自仅由RA患者组成的名义小组，另一个来自仅由风湿病专家组成的名义小组，然后将障碍分类为不同主题。接下来，通过在线调查，要求从Corrona注册库中随机抽取的RA患者样本对实现疾病控制的三大障碍进行排序。
四个名义小组共37名RA患者确定了影响RA活动控制的患者障碍，这些障碍被分类为17个主题。三个名义小组共25名风湿病专家确定了障碍，这些障碍被分类为11个主题。RA护理的财务方面在两类名义小组中均排名第一，而药物风险规避在医生名义小组所感知的障碍中排名第二，在RA患者名义小组所感知的障碍中排名第三。在接受调查的450名RA患者中，77%认为RA是首要的健康问题，51%报告知晓RA护理的达标治疗策略；患者认为实现疾病控制的三大最重要挑战是RA预后不确定、药物风险规避以及与RA护理相关的财务/行政负担。
在实现RA疾病控制方面，存在患者和风湿病专家报告的常见且可能可改变的障碍，包括感知到的药物风险规避、次优的治疗依从性以及在RA疾病活动严格控制的益处方面患者与医生的沟通欠佳。解决这些障碍可能会提高对目标导向的RA护理的依从性。
