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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Main Authors: Bogdan Batko, Krzysztof Batko, Marcin Krzanowski, Zbigniew Żuber
Format: Article
Language:English
Published: MDPI AG 2019-09-01
Series:Journal of Clinical Medicine
Subjects:
Online Access:https://www.mdpi.com/2077-0383/8/9/1416
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spelling 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
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