Gaps in RA, SLE care deliver 'wake-up call' for health services in EU
Two studies presented at the EULAR Annual Congress revealed gaps between recommended standards of care and the actual care that patients in Europe are receiving for rheumatoid arthritis and systemic lupus erythematosus.
“It is concerning to see so many problematic gaps reported across many essential aspects of rheumatoid arthritis care,” Rachelle Meisters, PhD, of the Care and Public Health Research Institute at Maastricht University in the Netherlands, said in a press release.
Meisters and colleagues evaluated gaps in quality of care for patients with RA according to the 16 standards of care outlined on Eumusc.net, a EULAR- and E.U.-supported initiative. They conducted a survey that included 1,422 patients from 27 countries and 1,044 rheumatologists from 33 countries in Europe. The patients and rheumatologists rated the level of importance and care for each of the 16 standards of care on Eumusc.net.
Results indicated that the most problematic gap in RA standards of care was diagnosis within 6 weeks, which was reported by 52% of patients and 59% of rheumatologists. Other significant care gaps included information about patient organizations, which was reported by 40% of patients and 38% of rheumatologists; training on aids, devices, and ergonomic principles (39% of patients and 34% of rheumatologists); vaccination-related information (38% and 27%); receiving a regular evaluation schedule (33% and 23%); information about physical exercise (35% and 20%); and availability of a treatment plan (35% and 18%).
Other more positive findings showed that just 8% of patients and 3% of rheumatologists reported gaps in use of DMARD therapies.
“We hope these results act as a loud wake up call to services across Europe,” Meisters said.
In another study looking at patient care gaps in Europe, Anna Kernder, MD, of the Policlinic of Rheumatology and Hiller Research Unit at Heinrich-Heine-University Düsseldorf in Germany, and colleagues, noted that despite the existence of formal recommendations, there is ongoing uncertainty surrounding standards of care in SLE.
The study included self-reported data from 572 patients with SLE who were asked about use of antimalarials; osteoporosis protection using prednisone or an equivalent; vaccination; blood pressure; fat metabolism counseling; yearly urine and blood tests; treatment of fat metabolism disorder; osteoporosis; and hypertension. The researchers also asked about quality of life and disease activity parameters.
Results showed that just 61% of relevant care aspects were fulfilled. Looking at fulfillment of the various clinical care parameters, just 22.8% reported receiving fat metabolism counseling. However, 97.6% of the cohort reported receiving osteoporosis protection using a glucocorticoid.
Patients who had more of the quality measures fulfilled experienced a higher disease-related quality of life (P = .004), slower progress of damage associated with SLE (P = .048), and lower disease activity (P = .046).
“Our results show that consistent consideration of these care parameters, recommended in several management guidelines, yield a positive effect on outcome,” Kernder said in the press release. – by Rob Volansky
Kernder A, et al. OP0308.
Meisters R, et al. OP0307.
Presented at: EULAR Annual Congress; June 12-15, 2019; Madrid.
Disclosure: Kernder reports receiving grant or research support from GlaxoSmithKline and UCB Pharma. Meisters reports no relevant financial disclosures.