Rheumatologists and patients share several reported barriers to achieving disease control in rheumatoid arthritis, including a perceived medication risk aversion, suboptimal treatment adherence and a lack of effective communication regarding the benefits of RA disease control, according to recent findings in Arthritis Care & Research.
“A recent study found that patients with RA were unaware of the goals of the T2T strategy, prioritized symptom relief and ensuring function over decreasing disease activity or preventing disease progression,” Justin K. Owensby, PharmD, PhD, of the University of Alabama at Birmingham, and colleagues wrote. “Patients may decline treatment escalation recommended by professional guidelines because they fear worsening symptoms with switching therapies, a concern that outweighs their optimism for improvement with therapy escalation.”
“Moreover, while tight control of disease activity hinges on adherence to prescribed medications, only two-thirds of patients with RA are adherent to their prescribed DMARDs, for various reasons including competing comorbid conditions, medication cost, adverse events and side effects, as well as trust in their provider,” the researchers added. “Thus, while multiple physician and patient factors influence adherence to T2T strategy, the rheumatology community lacks a deep understanding of the challenges that rheumatologists and patients face when attempting to achieve better RA control.”
Rheumatologists and patients share several reported barriers to achieving disease control in RA, according to recent findings.
To identify and analyze patient- and rheumatologist-reported barriers to RA disease control, Owensby and colleagues surveyed individuals included in the Consortium of Rheumatology Researchers of North America (Corrona) registry. The registry features more than 750 physicians and more than 50,000 patients diagnosed with RA. Via email, researchers invited the rheumatologists and patients in Corrona to participate in hour-long nominal group sessions, which included an introduction and explanation, silent generation of ideas, sharing ideas, group discussion, and voting and ranking.
The researchers conducted three nominal group sessions with rheumatologists, totaling 25 participants, and four patient group sessions totaling 37 participants. Further, 1,528 random patients with RA from the Corrona registry were asked to rank their top three barriers to disease control in an online survey. Five hundred patients responded within three weeks, of whom 450 were included in the final analysis.
According to the researchers, the financial aspects of RA care ranked first among both rheumatologist and patient nominal groups regarding important barriers to RA disease control. Medication risk aversion ranked second among rheumatologists and third among patients. Meanwhile, among the 450 patient survey responders, 77% considered RA a top health priority, and 51% reported being aware of the treattotarget strategy for RA care. The three most important barriers to achieving disease control among these patients were RA prognosis uncertainty, medication risk aversion and care-related financial and administrative burdens.
“In addition, our results indicated patients were not aware of the guideline-recommended T2T approach. Thus, we believe that a behavioral intervention could help patients become better informed and engaged about evidence-based RA care,” Owensby and colleagues wrote. “Moreover, such an intervention addressing perceived obstacles to achieving disease control may facilitate meaningful conversations and shared decision making between patients and physicians, improve adherence to goal-directed RA care espoused by the T2T strategy, and thus result in improved quality of life of patients with RA.” – by Jason Laday
Disclosures: Owensby reports no relevant financial disclosures. Please see the full study for additional author disclosures.