Barriers to treatment optimization and achievement of patients’ goals: perspectives from people living with rheumatoid arthritis enrolled in the ArthritisPower registry
| Autor: | Jeffrey R. Curtis, W. Benjamin Nowell, K. Gavigan, Mylene S. Serna, Mohamed Yassine, Jeffrey L Stark |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Health Knowledge Attitudes Practice lcsh:Diseases of the musculoskeletal system Disease Treatment goals Physical function Arthritis Rheumatoid 03 medical and health sciences 0302 clinical medicine Internal medicine Surveys and Questionnaires medicine Humans 030212 general & internal medicine Registries Rheumatoid arthritis RAPID3 Aged 030203 arthritis & rheumatology Sleep disorder Physician-Patient Relations Patient-reported outcomes business.industry Middle Aged medicine.disease Rheumatology Real-world data Patient Outcome Assessment Cross-Sectional Studies Antirheumatic Agents Cohort Orthopedic surgery Physical therapy Female lcsh:RC925-935 business Goals Research Article |
| Zdroj: | Arthritis Research & Therapy, Vol 22, Iss 1, Pp 1-10 (2020) Arthritis Research & Therapy |
| ISSN: | 1478-6362 |
| Popis: | Background Few studies have investigated patients’ own treatment goals in rheumatoid arthritis (RA). The objective of this real-world, cross-sectional study of US patients with RA was to identify factors that patients believed influenced their physician’s treatment decisions. Secondary objectives included reasons patients tolerated sub-optimal disease control and their perceived barriers to treatment optimization. Methods Eligible participants were enrolled in the ArthritisPower registry, ≥ 19 years, had physician-diagnosed RA, unchanged treatment within 3 months of baseline, prior/current disease-modifying antirheumatic drug treatment (DMARDs), and computer/smartphone access. In December 2017, participants completed Patient-Reported Outcomes Measurement Information System-Computerized Adaptive Tests (PROMIS-CAT) for pain interference, fatigue, sleep disturbance, and physical function. Routine Assessment of Patient Index Data 3 (RAPID3) provided disease activity scores (0–30). Participants completed an online survey on barriers to treatment optimization, including self-perception of disease compared to RAPID3/PROMIS scores. Results A total of 249 participants met inclusion criteria and completed the survey. Mean age (SD) was 52 (11) years, and the majority were female (92%) with high RAPID3 disease activity (175/249 [70%]; median score 18). The main reason participants did not change treatment was their physician’s recommendation (66%; n = 32). Of participants with high RAPID3 disease activity, 66 (38%) were offered a treatment change; 19 (29%) of whom declined the change. Most participants who intensified treatment did so because their symptoms had remained severe or worsened (51%; n = 33); only 16 (25%) participants intensified because they had not reached a specified treatment goal. Among participants who self-reported their disease activity as “none/low” or “medium” (n = 202; 81% of cohort), most still had RAPID3 high disease activity (137/202 [68%]; score > 12). Most PROMIS scores showed moderate agreement with participants’ self-assessment of health status, in contrast to RAPID3 (weighted kappa: 0.05 [95% CI − 0.01, 0.11]). Conclusions Most participants trusted their rheumatologist’s treatment decisions and prioritized their physician’s treatment goals over their own. Patients should be encouraged to share their treatment goals/expectations with their rheumatologist, in line with the treat-to-target approach. RAPID3 may be inappropriate for setting patient-centric treatment goals given the poor agreement with self-reported disease activity; most PROMIS scores showed better alignment with patients’ own assessments. |
| Databáze: | OpenAIRE |
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