Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis
Principles of treat-to-target (T2T) have been widely adopted in both multinational and regional guidelines for rheumatoid arthritis (RA). Several questionnaire studies among physicians and real-world data have suggested that an evidence−practice gap exists in RA management. Investigating p...
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doaj-7214c93752a64a5684961eb25707f5542020-11-25T02:01:24ZengMDPI AGJournal of Clinical Medicine2077-03832019-09-0189141610.3390/jcm8091416jcm8091416Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid ArthritisBogdan Batko0Krzysztof Batko1Marcin Krzanowski2Zbigniew Żuber3Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Gustawa Herlinga-Grudźińskiego 1 St, 30-705 Cracow, PolandChair and Head of Nephrology, Jagiellonian University Medical College, Kopernika St 15c, 31-501 Cracow, PolandChair and Head of Nephrology, Jagiellonian University Medical College, Kopernika St 15c, 31-501 Cracow, PolandDepartment of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Gustawa Herlinga-Grudźińskiego 1 St, 30-705 Cracow, PolandPrinciples of treat-to-target (T2T) have been widely adopted in both multinational and regional guidelines for rheumatoid arthritis (RA). Several questionnaire studies among physicians and real-world data have suggested that an evidence−practice gap exists in RA management. Investigating physician adherence to T2T, which requires a process measure, is difficult. Different practice patterns among physicians are observed, while adherence to protocolized treatment declines over time. Rheumatologist awareness, agreement, and claims of adherence to T2T guidelines are not always consistent with medical records. Comorbidities, a difficult disease course, communication barriers, and individual preferences may hinder an intensive, proactive treatment stance. Interpreting deviations from protocolized treatment/T2T guidelines requires sufficient clinical context, though higher adherence seems to improve clinical outcomes. Nonmedical constraints in routine care may consist of barriers in healthcare structure and socioeconomic factors. Therefore, strategies to improve the institution of T2T should be tailored to local healthcare. Educational interventions to improve T2T adherence among physicians may show a moderate, although beneficial effect. Meanwhile, a proportion of patients with inadequately controlled RA exists, while management decisions may not be in accordance with T2T. Physicians tend to be aware of current guidelines, but their institution in routine practice seems challenging, which warrants attention and further study.https://www.mdpi.com/2077-0383/8/9/1416rheumatologistsarthritisrheumatoidphysicianspractice patternsphysicians’guideline adherencetreat-to-target |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Bogdan Batko Krzysztof Batko Marcin Krzanowski Zbigniew Żuber |
spellingShingle |
Bogdan Batko Krzysztof Batko Marcin Krzanowski Zbigniew Żuber Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis Journal of Clinical Medicine rheumatologists arthritis rheumatoid physicians practice patterns physicians’ guideline adherence treat-to-target |
author_facet |
Bogdan Batko Krzysztof Batko Marcin Krzanowski Zbigniew Żuber |
author_sort |
Bogdan Batko |
title |
Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis |
title_short |
Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis |
title_full |
Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis |
title_fullStr |
Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis |
title_full_unstemmed |
Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis |
title_sort |
physician adherence to treat-to-target and practice guidelines in rheumatoid arthritis |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2019-09-01 |
description |
Principles of treat-to-target (T2T) have been widely adopted in both multinational and regional guidelines for rheumatoid arthritis (RA). Several questionnaire studies among physicians and real-world data have suggested that an evidence−practice gap exists in RA management. Investigating physician adherence to T2T, which requires a process measure, is difficult. Different practice patterns among physicians are observed, while adherence to protocolized treatment declines over time. Rheumatologist awareness, agreement, and claims of adherence to T2T guidelines are not always consistent with medical records. Comorbidities, a difficult disease course, communication barriers, and individual preferences may hinder an intensive, proactive treatment stance. Interpreting deviations from protocolized treatment/T2T guidelines requires sufficient clinical context, though higher adherence seems to improve clinical outcomes. Nonmedical constraints in routine care may consist of barriers in healthcare structure and socioeconomic factors. Therefore, strategies to improve the institution of T2T should be tailored to local healthcare. Educational interventions to improve T2T adherence among physicians may show a moderate, although beneficial effect. Meanwhile, a proportion of patients with inadequately controlled RA exists, while management decisions may not be in accordance with T2T. Physicians tend to be aware of current guidelines, but their institution in routine practice seems challenging, which warrants attention and further study. |
topic |
rheumatologists arthritis rheumatoid physicians practice patterns physicians’ guideline adherence treat-to-target |
url |
https://www.mdpi.com/2077-0383/8/9/1416 |
work_keys_str_mv |
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