Batko Bogdan, Kucharz Eugeniusz, Stajszczyk Marcin, Brzosko Marek, Samborski Włodzimierz, Żuber Zbigniew
Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, 30-705 Krakow, Poland.
Department of Internal Medicine, Rheumatology and Clinical Immunology, Medical University of Silesia, 40-752 Katowice, Poland.
J Clin Med. 2021 Sep 11;10(18):4106. doi: 10.3390/jcm10184106.
Real-world data indicate disparities in biologic access across Europe.
To describe the national structure of PsA care in Poland, with a particular focus on the population of inadequate responders (IRs) and difficulties associated with biologic therapy access.
A pool of rheumatologic and dermatologic care centers was created based on National Health Fund contract lists ( = 841), from which 29 rheumatologic and 10 dermatologic centers were sampled randomly and successfully met the inclusion criterium. Additionally, 33 tertiary care centers were recruited. For successful center recruitment, one provider had to recruit at least one patient that met the criteria for one of the four pre-defined clinical subgroups, in which all patients had to have active PsA and IR status to at least 2 conventional synthetic disease-modifying drugs (csDMARDs). Self-assessment questionnaires were distributed among physicians and their patients.
Barriers to biologic DMARD (bDMARD) treatment are complex and include stringency of reimbursement criteria, health care system, logistic/organizational, and personal choice factors. For patients who are currently bDMARD users, the median waiting time from the visit, at which the reimbursement procedure was initiated, to the first day of bDMARD admission was 9 weeks (range 2-212; 32% < 4 weeks, 29% 5-12 weeks, 26% 13-28 weeks, 13% with >28 weeks delay). Out of all inadequate responder groups, bDMARD users are the only group with "good" therapeutic situation and satisfaction with therapy. Patient satisfaction with therapy is not always concordant with physician assessment of therapeutic status.
Despite the fact that over a decade has passed since the introduction of biologic agents, in medium welfare countries such as Poland, considerable healthcare system barriers to biologic access are present. Out of different IR populations, patient satisfaction with treatment is often discordant with physician assessment of disease status.
真实世界数据表明欧洲各地在生物制剂获取方面存在差异。
描述波兰银屑病关节炎（PsA）护理的国家结构，特别关注疗效不佳者（IRs）群体以及生物治疗获取方面的困难。
根据国家卫生基金合同清单创建了一个风湿科和皮肤科护理中心库（=841个），从中随机抽取了29个风湿科中心和10个皮肤科中心，这些中心成功符合纳入标准。此外，还招募了33个三级护理中心。为成功招募中心，一名提供者必须至少招募一名符合四个预定义临床亚组之一标准的患者，其中所有患者必须患有活动性PsA且对至少两种传统合成改善病情抗风湿药物（csDMARDs）疗效不佳。自我评估问卷分发给医生及其患者。
生物改善病情抗风湿药物（bDMARD）治疗的障碍很复杂，包括报销标准的严格性、医疗保健系统、后勤/组织以及个人选择因素。对于目前使用bDMARD的患者，从启动报销程序的就诊到bDMARD入院第一天的中位等待时间为9周（范围2 - 212周；32% < 4周，29%为5 - 12周，26%为13 - 28周，13%延迟>28周）。在所有疗效不佳者群体中，bDMARD使用者是唯一具有“良好”治疗状况和治疗满意度的群体。患者对治疗的满意度并不总是与医生对治疗状况的评估一致。
尽管生物制剂引入已过去十多年，但在波兰这样的中等福利国家，生物制剂获取仍存在相当大的医疗保健系统障碍。在不同的疗效不佳者群体中，患者对治疗的满意度往往与医生对疾病状况的评估不一致。
