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Al-Yateem N, Mottershead R, Refaat Ahmad F, Arsyad Subu M. A reflection on the use of virtual nominal group technique in health policy and research priority consensus studies. Nurse Res 2024; 32:35-41. [PMID: 38932484 DOI: 10.7748/nr.2024.e1933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Nominal group technique (NGT) is widely used in healthcare research to facilitate decision-making and consensus-building. Traditional NGT requires face-to-face interaction and its limitations include potential biases, logistical challenges and high costs. The COVID-19 pandemic necessitated a shift to virtual methods, which led to the development of virtual nominal group technique (vNGT). Aim To reflect on the use of vNGT, particularly in the context of Ghader et al (2023 ), to understand its effectiveness in overcoming the limitations of traditional NGT and on its applicability in pandemic-affected scenarios. METHOD This paper reviews and discusses literature on the use and effectiveness of NGT compared to other consensus-building methods and examines the emergence of vNGT in overcoming the limitations of traditional NGT. The authors also reflect on their use of vNGT in a study to identify cardiovascular research priorities in the UAE and provide details of its implementation. DISCUSSION vNGT bridges the gap between the localised nature of traditional NGT and the global reach of the Delphi technique. It allows for the inclusion of diverse participants, saves costs and offers time-efficiency. The study demonstrated vNGT's adaptability, with participants engaging in idea generation, discussion and prioritisation using online tools. However, challenges persist with vNGT, including reduced accessibility for certain demographics, timing issues across time zones and technical difficulties. CONCLUSION vNGT successfully integrates the interactive, consensus-building aspects of NGT with the broad reach of Delphi. It can be valuable in research and decision-making, especially in an era of increased remote collaboration. IMPLICATIONS FOR PRACTICE vNGT can significantly impact healthcare research and policy formulation by enabling more inclusive, cost-effective and timely consensus-building processes. However, considerations for accessibility and technical support are crucial for its wider adoption and effectiveness.
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Affiliation(s)
- Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Richard Mottershead
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Fatma Refaat Ahmad
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Muhammad Arsyad Subu
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Rudin RS, Garabedian PM, Solomon DH. Know Thy User: Designing Digital Tools for Rheumatology Patients. J Rheumatol 2024; 51:845-847. [PMID: 39089841 DOI: 10.3899/jrheum.2024-0684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Affiliation(s)
| | | | - Daniel H Solomon
- D.H. Solomon, MD, MPH, Harvard Medical School, Boston, Massachusetts, USA
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Nowell WB, Gavigan K, Garza K, O'Beirne R, Safford M, George M, Ogdie A, Walsh JA, Danila MI, Venkatachalam S, Stradford L, Rivera E, Curtis JR. Which Educational Topics and Smartphone App Functions Are Prioritized by US Patients With Rheumatic and Musculoskeletal Diseases? A Mixed-Methods Study. J Rheumatol 2024; 51:904-912. [PMID: 38749562 DOI: 10.3899/jrheum.2023-1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 06/17/2024]
Abstract
OBJECTIVE We sought to identify (1) what types of information US adults with rheumatic and musculoskeletal diseases (RMD) perceive as most important to know about their disease, and (2) what functions they would use in an RMD-specific smartphone app. METHODS Nominal groups with patients with RMD were conducted using online tools to generate a list of needed educational topics. Based on nominal group results, a survey with final educational items was administered online, along with questions about desired functions of a smartphone app for RMD and wearable use, to patients within a large community rheumatology practice-based research network and the PatientSpot registry. Chi-square tests and multivariate regression models were used to determine differences in priorities between groups of respondents with rheumatic inflammatory conditions (RICs) and osteoarthritis (OA), and possible associations. RESULTS At least 80% of respondents considered finding a rheumatologist, understanding tests and medications, and quickly recognizing and communicating symptoms to doctors as extremely important educational topics. The highest-ranked topic for both RIC and OA groups was "knowing when the medication is not working." The app functions that most respondents considered useful were viewing laboratory results, recording symptoms to share with their rheumatology provider, and recording symptoms (eg, pain, fatigue) or disease flares for health tracking over time. Approximately one-third of respondents owned and regularly used a wearable activity tracker. CONCLUSION People with RMD prioritized information about laboratory test results, medications, and disease and symptom monitoring, which can be used to create educational and digital tools that support patients during their disease journey.
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Affiliation(s)
- William B Nowell
- W.B. Nowell, MSW, PhD, K. Gavigan, MPH, S. Venkatachalam, MPH, PhD, L. Stradford, MPH, E. Rivera, MS, Global Healthy Living Foundation, Upper Nyack, New York
| | - Kelly Gavigan
- W.B. Nowell, MSW, PhD, K. Gavigan, MPH, S. Venkatachalam, MPH, PhD, L. Stradford, MPH, E. Rivera, MS, Global Healthy Living Foundation, Upper Nyack, New York;
| | - Kimberly Garza
- K. Garza, PharmD, MBA, PhD, Auburn University, Harrison College of Pharmacy, Auburn, Alabama
| | - Ronan O'Beirne
- R. O'Beirne, EdD, Division of Continuing Medical Education, University of Alabama at Birmingham, Birmingham, Alabama
| | - Monika Safford
- M. Safford, MD, Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Michael George
- M. George, MD, MSCE, A. Ogdie, MD, MSCE, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexis Ogdie
- M. George, MD, MSCE, A. Ogdie, MD, MSCE, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jessica A Walsh
- J.A. Walsh, MD, University of Utah, and George E. Wahlen Veterans Affairs Medical Center, Rheumatology, Salt Lake City, Utah
| | - Maria I Danila
- M.I. Danila, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, and Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
| | - Shilpa Venkatachalam
- W.B. Nowell, MSW, PhD, K. Gavigan, MPH, S. Venkatachalam, MPH, PhD, L. Stradford, MPH, E. Rivera, MS, Global Healthy Living Foundation, Upper Nyack, New York
| | - Laura Stradford
- W.B. Nowell, MSW, PhD, K. Gavigan, MPH, S. Venkatachalam, MPH, PhD, L. Stradford, MPH, E. Rivera, MS, Global Healthy Living Foundation, Upper Nyack, New York
| | - Esteban Rivera
- W.B. Nowell, MSW, PhD, K. Gavigan, MPH, S. Venkatachalam, MPH, PhD, L. Stradford, MPH, E. Rivera, MS, Global Healthy Living Foundation, Upper Nyack, New York
| | - Jeffrey R Curtis
- J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Kakehasi AM, Duarte ALBP, Brenol CV, Domiciano DS, Laurindo IMM, Bonfiglioli KR, da Mota LMH, Buch MH, de Almeida Macêdo E, Xavier RM. Challenges in implementing treat-to-target in rheumatoid arthritis: a perspective from Brazilian rheumatologists. Adv Rheumatol 2024; 64:63. [PMID: 39187901 DOI: 10.1186/s42358-024-00403-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Patient management in rheumatoid arthritis (RA) has evolved to a "treat-to-target" (T2T) approach, which entails intensive treatment and regular follow-up with the goal of achieving low levels of disease activity or clinical remission. Even though a T2T approach is endorsed by professional organizations and yields superior outcomes, its implementation remains incomplete. EVEREST (EleVatE care in RhEumatoid arthritiS with Treat-to-target) is a quality-improvement initiative designed to improve the widespread implementation of a personalized T2T strategy and enable patients with RA to reach their full potential for remission. We describe the Brazilian results from the Global T2T Survey, first part of the EVEREST program. METHODS Between June and September 2022, we conducted an online survey targeting rheumatologists in Brazil. Our objective was to evaluate the barriers and knowledge gaps hindering the effective implementation of T2T strategies. To achieve this, we employed a set of multiple-choice questions specifically crafted to elicit responses categorized in a structured order. RESULTS 166 rheumatologists participated in the survey, 51% of them with more than 21 years of experience in rheumatology. Regarding the perceived challenges in the management of RA in clinical practice, the highest percentage of agreement/strong agreement among the participants was related to the contradictory results of disease activity measures (60%). In terms of the main barriers to assess the disease activity in clinical practice, the lack of adherence to treatment and contradictory assessments between patient-reported outcomes and composite measures were indicated by 75% and 59% of the participants, respectively, as a moderate/serious barrier. The most frequently knowledge and skill gaps related to the management of RA pointed out by the participants were on the difficulty to assess patients' health literacy (54% stated to have no more than intermediate knowledge on standardized methods to assess it and 43% no more than intermediate skills on determining the level of health literacy of the patients). In general, the use of tools to support the management of RA patients in clinical practice was indicated to be unusual by the participants. Self-reflection questionnaires, patient education materials and treatment consideration checklists were pointed out as the least frequently used tools (85%, 64% and 62% of the participants stated to use them never, rarely, or only sometimes, respectively). CONCLUSIONS Our findings indicate a greater need for design, selection, and uptake of practical strategies to further improve communication between healthcare providers and patients with RA, as well as for promoting well-informed, collaborative decision-making in their care.
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Affiliation(s)
- Adriana Maria Kakehasi
- Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190, Belo Horizonte, Brazil.
| | | | | | | | | | | | | | - Maya H Buch
- NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK
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Lee SH, ten Cate O, Gottlieb M, Horsley T, Shea B, Fournier K, Tran C, Chan T, Wood TJ, Humphrey-Murto S. The use of virtual nominal groups in healthcare research: An extended scoping review. PLoS One 2024; 19:e0302437. [PMID: 38865305 PMCID: PMC11168680 DOI: 10.1371/journal.pone.0302437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 04/03/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION The Nominal Group Technique (NGT) is a consensus group method used to synthesize expert opinions. Given the global shift to virtual meetings, the extent to which researchers leveraged virtual platforms is unclear. This scoping review explores the use of the vNGT in healthcare research during the COVID-19 pandemic. METHODS Following the Arksey and O'Malley's framework, eight cross-disciplinary databases were searched (January 2020-July 2022). Research articles that reported all four vNGT stages (idea generation, round robin sharing, clarification, voting) were included. Media Synchronicity Theory informed analysis. Corresponding authors were surveyed for additional information. RESULTS Of 2,589 citations, 32 references were included. Articles covered healthcare (27/32) and healthcare education (4/32). Platforms used most were Zoom, MS Teams and GoTo but was not reported in 44% of studies. Only 22% commented on the benefits/challenges of moving the NGT virtually. Among authors who responded to our survey (16/32), 80% felt that the vNGT was comparable or superior. CONCLUSIONS The vNGT provides several advantages such as the inclusion of geographically dispersed participants, scheduling flexibility and cost savings. It is a promising alternative to the traditional in-person meeting, but researchers should carefully describe modifications, potential limitations, and impact on results.
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Affiliation(s)
- Seung Ho Lee
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Olle ten Cate
- Utrecht Center for Research and Development of Health Professions Education, Division of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago Illinois, United States of America
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Research, Ottawa Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Beverley Shea
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karine Fournier
- Health Sciences Library, University of Ottawa, Ottawa Ontario, Canada
| | - Christopher Tran
- Department of Medicine, University of Ottawa, Ottawa Ontario, Canada
| | - Teresa Chan
- Department of Medicine, Division of Emergency Medicine, Division of Education and Innovation, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Timothy J. Wood
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Susan Humphrey-Murto
- Department of Medicine, University of Ottawa, Ottawa Ontario, Canada
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
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Greene GJ, Beaumont JL, Bacalao EJ, Muftic A, Kaiser K, Eisenstein AR, Mandelin AM, Cella D, Ruderman EM. Integrating PROMIS Measures in a Treat-to-Target Approach to Standardize Patient-Centered Treatment of Rheumatoid Arthritis. J Rheumatol 2023; 50:1002-1008. [PMID: 37127317 PMCID: PMC11210325 DOI: 10.3899/jrheum.2022-1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To evaluate the effect of a patient-centered rheumatoid arthritis (RA) treat-to-target (T2T) disease management approach on patient outcomes and patient satisfaction with care. METHODS In this longitudinal, observational pilot study, rheumatologists implemented a modified T2T approach that integrated Patient Reported Outcomes Measurement Information System (PROMIS) measures for depression, fatigue, pain interference, physical function, and social function into RA care. Study participants selected 1 PROMIS domain to target treatment and completed quarterly follow-up assessments. Participants were classified as improved if their Clinical Disease Activity Index (CDAI) changed by > 5 points. Change in PROMIS t scores was examined for the group with improved CDAI, and then compared to those with unchanged or worsened CDAI. Satisfaction with care was assessed using multiple measures, including the Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-Patient Satisfaction Scale. RESULTS The analytical sample (n = 119, median age 57 years, 90.8% female) was split between those with CDAI > 10 (n = 63) and CDAI ≤ 10 (n = 53). At 1 year, there was improvement in CDAI by > 5 points in 66% and 13% of individuals with baseline CDAI > 10 and baseline CDAI ≤ 10, respectively. Across all participants, improvement in CDAI by > 5 points correlated with improvements in the 5 PROMIS domains. Satisfaction with RA treatment also increased. CONCLUSION The integration of PROMIS measures into the T2T approach for RA care was associated with improvements in disease activity, and improvement in disease activity was associated with improvements in PROMIS measures.
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Affiliation(s)
- George J Greene
- G.J. Greene, PhD, A. Muftic, BSW, K. Kaiser, PhD, A.R. Eisenstein, PhD, D. Cella, PhD, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois;
| | - Jennifer L Beaumont
- J.L. Beaumont, MS, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and Clinical Outcomes Solutions, Tucson, Arizona
| | - Emily J Bacalao
- E.J. Bacalao, BS, A.M. Mandelin, MD, PhD, E.M. Ruderman, MD, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Azra Muftic
- G.J. Greene, PhD, A. Muftic, BSW, K. Kaiser, PhD, A.R. Eisenstein, PhD, D. Cella, PhD, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen Kaiser
- G.J. Greene, PhD, A. Muftic, BSW, K. Kaiser, PhD, A.R. Eisenstein, PhD, D. Cella, PhD, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy R Eisenstein
- G.J. Greene, PhD, A. Muftic, BSW, K. Kaiser, PhD, A.R. Eisenstein, PhD, D. Cella, PhD, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Arthur M Mandelin
- E.J. Bacalao, BS, A.M. Mandelin, MD, PhD, E.M. Ruderman, MD, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Cella
- G.J. Greene, PhD, A. Muftic, BSW, K. Kaiser, PhD, A.R. Eisenstein, PhD, D. Cella, PhD, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric M Ruderman
- E.J. Bacalao, BS, A.M. Mandelin, MD, PhD, E.M. Ruderman, MD, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Curtis JR, Fiore S, Ford K, Janak JC, Chang H, Pappas DA, Blachley T, Emeanuru K, Bykerk VP. Meaningful Improvement and Worsening in Patients Who Do Not Achieve Low Disease Activity and Switch Therapy to a New Biologic or Targeted Disease-Modifying Antirheumatic Drug: Results From the CorEvitas RA Registry. J Clin Rheumatol 2023; 29:e47-e51. [PMID: 37000177 DOI: 10.1097/rhu.0000000000001956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
OBJECTIVE The aim of this study was to assess the change in disease activity associated with switching from 1 biologic/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) to another in patients with rheumatoid arthritis who did not achieve low disease activity (LDA) after 6 to 12 months of their initial treatment. METHODS This observational study included patients from the CorEvitas Rheumatoid Arthritis Registry, who initiated a b/tsDMARD at the index visit (prebaseline), had any clinical disease activity index (CDAI) improvement but did not achieve LDA/remission at the subsequent visit (baseline), and switched therapy at baseline or between baseline and follow-up visits. Regardless of the preswitch CDAI value, 2 thresholds of CDAI change were used to define meaningful improvement and worsening for all patients: ≥6 units and ≥12 units; no meaningful change was defined as any change between -6 to +6 units and -12 to +12 units, based on respective thresholds. RESULTS Of 1226 patients fulfilling the inclusion criteria, 93 (7.6%) switched therapy at baseline or between baseline and follow-up, after an inadequate response at the baseline visit. At follow-up, meaningful worsening occurred in 30.1% and 12.9% of switchers, whereas the remaining switchers achieved meaningful improvement (34.4% and 20.4%) or had no meaningful change (35.5% and 66.7%), based on the thresholds of ≥6 and ≥12 units, respectively. CONCLUSIONS Rheumatoid arthritis patients, who had not achieved LDA and switched b/tsDMARD, were more likely to have meaningful improvement or no change, rather than meaningful worsening. These data may help some patients overcome their hesitancy to switch therapy, potentially improving clinical outcomes.
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Santos-Moreno P, Rodríguez-Vargas GS, Martínez S, Ibatá L, Villarreal-Peralta L, Aza-Cañon A, Rivero M, Rodriguez P, Rojas-Villarraga A. Better Clinical Results in Rheumatoid Arthritis Patients Treated Under a Multidisciplinary Care Model When Compared with a National Rheumatoid Arthritis Registry. OPEN ACCESS RHEUMATOLOGY: RESEARCH AND REVIEWS 2022; 14:269-280. [PMID: 36426199 PMCID: PMC9680987 DOI: 10.2147/oarrr.s385423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
Purpose To describe clinical characteristics and effectiveness of health care in patients with rheumatoid arthritis (RA) as part of a multidisciplinary care model (MCM) in a specialized rheumatology center, compared with the results of a national registry of RA (NARRA) as evidence of real-world management. Patients and Methods We conducted a real-world study (July 1, 2018 to June 30, 2019) based on an analysis of electronic health records of a cohort of RA patients managed with the “Treat-to-Target” strategy in a specialized rheumatology center in Colombia with an MCM, compared with the NARRA that includes different models of usual care. Results We have analyzed 7053 subjects with RA treated at a specialized rheumatology center and 81,492 patients from the NARRA. Cohorts were similar in their baseline characteristics, with women in predominance and diagnosis age close to 50 years. At the time of diagnosis, a higher proportion of clinical diagnostic test use and rheumatology consultation access was observed in the specialized rheumatology center than in the national registry (4–6 per year versus three or less). In addition, higher proportions of patients in remission and low disease activity were reported for the specialized rheumatology center, with a >40% amount of data lost in the national registry. Pharmacological management was similar regarding the analgesic use. In the specialized center, Certolizumab was more frequently used than in the NARRA registry; also, there were significant differences in methotrexate, leflunomide, and sulfasalazine use, being higher in the specialized rheumatology center. Conclusion The MCM of a specialized center in RA can guarantee comprehensive care, with better access to all the services required to manage the disease. It ensures specialist management and evidence-based care that facilitates the achievement of therapeutic objectives. In addition, better patient records and follow-ups are available to evaluate health outcomes.
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Affiliation(s)
- Pedro Santos-Moreno
- Rheumatology Department, Biomab IPS, Bogotá, Colombia
- Correspondence: Pedro Santos-Moreno, Rheumatology Department, Biomab IPS, Calle 48 # 13-86, Bogotá, Colombia, Tel +57 320 8094232, Email
| | | | - Susan Martínez
- Epidemiology Department, Epithink Health Consulting, Bogotá, Colombia
| | - Linda Ibatá
- Epidemiology Department, Epithink Health Consulting, Bogotá, Colombia
| | | | | | - Manuel Rivero
- Rheumatology Department, Biomab IPS, Bogotá, Colombia
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Miura T, Miyakoshi N, Kashiwagura T, Tsuchie H, Sugimura Y, Shimada Y. The association between comorbidities and disease activity in patients with rheumatoid arthritis: a multicenter, cross-sectional cohort study in Japan with the highest proportion of elderly individuals. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-021-00109-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aimed to assess the association of disease activity with the presence of comorbidities in patients with rheumatoid arthritis, using the Akita Orthopedic Group on Rheumatoid Arthritis (AORA) registry, a multicenter, cross-sectional registry in Japan with the highest proportion of elderly people. We included 1838 patients (mean age: 66.4 years old) who visited our affiliated institutions between April 2018 and March 2019. The patients were divided into two groups based on the disease activity in 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR) into the remission or low disease activity group (L group) and the moderate or high disease activity group (H group). Patient demographics and comorbidities in the two groups were compared.
Results
The most common comorbidity was hypertension (33.7%), followed by renal disease (25.2%), respiratory disease (12.2%), diabetes mellitus (8.1%), cardiovascular disease (8.0%), malignancies (5.7%), and cerebrovascular disease (4.7%). The H group was older (p<0.0001); had a higher prevalence of hypertension (p<0.0001), diabetes (p=0.0011), respiratory disease (p<0.0001), cerebrovascular disease (p<0.0001), and cardiovascular disease (p=0.0030); and was less likely to use anti-rheumatic drugs. The prevalence of comorbidities other than renal disease and malignant tumor was higher in the H group. Multivariate logistic regression analysis showed that female sex (p=0.0054), advanced Steinbrocker class (p<0.0001), high anti-citrullinated protein antibody levels (p=0.0211), high prednisolone dose (p<0.0001), and absence of biologics’ or JAK inhibitors’ use (p<0.0001) were risk factors for high disease activity, and shorter treatment period was a low-risk factor for high disease activity (p=0.0041). Among comorbidities, the presence of cerebrovascular disease (p=0.0334) was the only independent risk factor for high disease activity.
Conclusions
In our registry study with a high proportion of elderly RA patients, cerebrovascular disease was associated with high disease activity in patients with RA. Therefore, when treating elderly patients with RA, we need to pay careful attention to cerebrovascular disease, and treatment should be aimed at achieving adequate control of RA.
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Danila MI, Chen L, Ruderman EM, Owensby JK, O'Beirne R, Melnick JA, Harrold LR, Curtis D, Nowell WB, Curtis JR. Evaluation of an Intervention to Support Patient-Rheumatologist Conversations About Escalating Treatment in Patients with Rheumatoid Arthritis: A Proof-of-Principle Study. ACR Open Rheumatol 2021; 4:279-287. [PMID: 34962093 PMCID: PMC8992469 DOI: 10.1002/acr2.11393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 12/03/2022] Open
Abstract
Objective This study’s objective was to test whether an online video intervention discussing appropriate treatment escalation improves willingness to change treatment in people living with rheumatoid arthritis (RA). Methods We conducted a controlled, randomized trial among patients with RA enrolled in ArthritisPower, a United States patient registry. We recruited participants by email and surveyed their assessment of disease activity (patient global), satisfaction with disease control (patient acceptable symptom state), attitudes about RA medications, decisional conflict (decisional conflict scale), and willingness to modify RA treatment (choice predisposition scale, higher scores are better) if or when recommended by their rheumatologist. Intervention groups watched educational videos relevant to a treat‐to‐target (T2T) strategy, whereas control groups viewed vaccination‐related videos as an “attention control.” We compared the between‐group difference in patients’ willingness to modify RA treatment (primary outcome) and difference in decisional conflict about changing RA treatment (secondary outcome) after watching the videos using t tests. Results Participants with self‐reported RA (n = 208) were 90% White and 90% women, with a mean (standard deviation) age of 50 (11) years, and 52% reported familiarity with the RA T2T strategy. We found a significant improvement in between‐group difference in willingness to change RA treatment among intervention versus control participants (0.49 [95% confidence interval 0.09‐0.88], P = 0.02). The effect size (Glass’s delta) for the intervention was 0.48. Decisional conflict about treatment change decreased, but the between‐group difference was not significant. Conclusion This novel educational patient‐directed intervention discussing appropriate treatment escalation was associated with improved willingness to change RA treatment if or when recommended by a rheumatologist. Further studies should evaluate whether this change in patients’ predisposition translates into actual treatment escalation.
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Affiliation(s)
- Maria I Danila
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Lang Chen
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Ronan O'Beirne
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Leslie R Harrold
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - David Curtis
- Global Healthy Living Foundation, Upper Nyack, New York
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O'Neill KD, Marks KE, Sinicrope PS, Crowson CS, Symons D, Myasoedova E, Davis JM. Importance of Shared Treatment Goal Discussions in Rheumatoid Arthritis-A Cross-Sectional Survey: Patients Report Providers Seldom Discuss Treatment Goals and Outcomes Improve When Goals Are Discussed. ACR Open Rheumatol 2021; 3:870-878. [PMID: 34535987 PMCID: PMC8672176 DOI: 10.1002/acr2.11335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/02/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Treat‐to‐target (T2T) and shared decision‐making are valued features of current guidelines for rheumatoid arthritis (RA) management. Although T2T has demonstrated value for improving RA outcomes, implementation remains inconsistent and lacks standardization and procedures for including patient input. We sought to better understand the impact of shared decisions on T2T and how treatment goal discussions between patients and providers impact RA treatment improvement and satisfaction. Methods An anonymous, web‐based questionnaire was presented to United States residents aged 18 years or older with a self‐reported diagnosis of RA by a medical professional with 28 questions regarding socio‐demographics, RA disease activity (DA), diagnosis, treatments, outcomes, and goals. Analyses included descriptive statistics with χ2 and rank sum tests for comparisons. Results The questionnaire was completed by 907 people (mean age of 58 years; mean 11 years since diagnosis; 90% female). The majority (571; 63%) did not discuss RA treatment goals with providers. Patients engaging in treatment goal discussions with their providers were three times more likely to be satisfied with their treatment plans. Patients discussing treatment goals with their providers were more likely to have improved DA levels and 68% more likely to reach remission. Conclusion A majority of patients with RA report having no treatment goal discussion with their providers; however, these discussions are associated with greater DA improvement and treatment satisfaction. Further research should seek understanding of how shared treatment goal discussions relate to successful RA management and explore the development of practical tools to implement them in regular clinic practice as part of a T2T regimen.
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Affiliation(s)
| | - Kathryne E Marks
- Rheumatoid Patient Foundation, Lutz, Florida, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Pamela S Sinicrope
- Rheumatoid Patient Foundation, Lutz, Florida, and Mayo Clinic, Rochester, Minnesota
| | | | - Dana Symons
- Rheumatoid Patient Foundation, Lutz, Florida
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Bekker CL, Bossina S, de Vera MA, Bartlett SJ, de Wit M, March L, Shea B, Evans V, Richards D, Tong A, Tugwell P, Tymms K, Scholte-Voshaar M, Kelly A, van den Bemt BJF. Patient Perspectives on Outcome Domains of Medication Adherence Trials in Inflammatory Arthritis: An International OMERACT Focus Group Study. J Rheumatol 2021; 48:1480-1487. [PMID: 33993113 DOI: 10.3899/jrheum.201568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the perspectives of patients with inflammatory arthritis (IA) on outcome domains of trials evaluating medication adherence interventions. METHODS Adult patients (≥ 18 yrs) with IA taking disease-modifying antirheumatic drugs from centers across Australia, Canada, and the Netherlands participated in 6 focus groups to discuss outcome domains that they consider important when participating in medication adherence trials. We analyzed the transcripts using inductive thematic analysis. RESULTS Of the 38 participants, 23 (61%) had rheumatoid arthritis and 21 (55%) were female. The mean age was 57.3 ± (SD 15.0) years. Improved outcome domains that patients wanted from participating in an adherence trial were categorized into 5 types: medication adherence, adherence-related factors (supporting adherence; e.g., medication knowledge), pathophysiology (e.g., physical functioning), life impact (e.g., ability to work), and economic impact (e.g., productivity loss). Three overarching themes reflecting why these outcome domains matter to patients were identified: how taking medications could improve patients' emotional and physical fitness to maintain their social function; how improving knowledge and confidence in self-management increases patients' trust and motivation to take medications as agreed with minimal risk of harms; and how respect and reassurance, reflecting health care that values patients' opinions and is sensitive to patients' individual goals, could improve medication-taking behavior. CONCLUSION Patients value various outcome domains related to their overall well-being, confidence in medication use, and patient-healthcare provider relationships to be evaluated in future adherence trials.
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Affiliation(s)
- Charlotte L Bekker
- C.L. Bekker, PhD, Radboud University Medical Centre, Research Institute for Health Sciences, Nijmegen, the Netherlands;
| | - Sacha Bossina
- S. Bossina, MSc, Department of Rheumatology, Liverpool Hospital, Sydney, Australia
| | - Mary A de Vera
- M.A. de Vera, Assistant Professor, PhD, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Susan J Bartlett
- S.J. Bartlett, Professor, PhD, Department of Medicine, McGill University and Research Institute, McGill University Health Centres, Montreal, Québec, Canada, and Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Maarten de Wit
- M. de Wit, PhD, OMERACT Patient Research Partner, the Netherlands
| | - Lyn March
- L. March, Professor, PhD, Institute of Bone and Joint Research, Kolling Institute of Medical Research, and Department of Rheumatology, Royal North Shore Hospital, and Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Beverley Shea
- B. Shea, PhD, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Vicki Evans
- V. Evans, Adjunct Assistant Professor, PhD, BOptom, Faculty of Health, University of Canberra, Canberra, Australia
| | - Dawn Richards
- D. Richards, PhD, Five02 Labs Inc., and Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Allison Tong
- A. Tong, Professor, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Peter Tugwell
- P. Tugwell, Professor, MD, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathleen Tymms
- K. Tymms, Associate Professor, MBBS, FRACP, College of Health and Medicine, Australian National University, and Department of Rheumatology, Canberra Hospital, Canberra, Australia
| | - Marieke Scholte-Voshaar
- M. Scholte-Voshaar, MSc, OMERACT Patient Research Partner, and University of Twente, Enschede, the Netherlands
| | - Ayano Kelly
- A. Kelly, Clinical Associate Lecturer, MBBS, FRACP, Department of Rheumatology, Liverpool Hospital, Sydney, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, College of Health and Medicine, Australian National University, Canberra, and South Western Clinical School, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Bart J F van den Bemt
- B.J. van den Bemt, Professor, PharmD, Radboud University Medical Centre, Research Institute for Health Sciences, and Sint Maartenskliniek, Nijmegen, the Netherlands. The authors declare no conflicts of interest relevant to this article
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Bobos P, MacDermid J, Ziebart C, Boutsikari E, Lalone E, Ferreira L, Grewal R. Barriers, facilitators, preferences and expectations of joint protection programmes for patients with hand arthritis: a cross-sectional survey. BMJ Open 2021; 11:e041935. [PMID: 33483445 PMCID: PMC7831706 DOI: 10.1136/bmjopen-2020-041935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 01/06/2021] [Accepted: 01/13/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The objective of this survey was to investigate the barriers, facilitators, expectations and patient preferences regarding joint protection (JP) programmes in people with hand arthritis. DESIGN Cross-sectional survey. SETTING Tertiary clinic. PARTICIPANTS Patients with hand arthritis: osteoarthritis, rheumatoid arthritis, psoriatic arthritis and other forms of arthritis. PRIMARY AND SECONDARY OUTCOME MEASURES This study used a survey among people with hand arthritis. Descriptive statistics and percentages were reported for all the data about the barriers, facilitators and preferences around JP. RESULTS A total of 192 patients consented to participate. Most of the patients (82%) were unaware of JP. Factors that may act as barriers to participation and were regarded as 'a very big concern' were: cost of the programme (44%), time of offering the programme (39%), work commitments (36%) and having a centre/clinic close to the house (28%). Factors that may act as facilitators and rated as 'extremely helpful' were: research that shows that JP works (26%) and having the centre/clinic close to the house (25%). An online format for JP was the most preferred option (54%). Half (46%) preferred a timeframe of 1 hour, three times per week and 44% preferred a 2-hour programme, for three times per week. CONCLUSIONS Awareness of the potential benefits of JP, and prior experience with JP programme were very low. Common potentially modifiable patient-reported barriers to participate in future JP interventions, included: cost, work commitments, distance from home to clinic and times that the intervention were provided. These barriers might be addressed with free and accessible forms of delivery of JP, which may lead to better uptake and participation in JP programmes.
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Affiliation(s)
- Pavlos Bobos
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Dalla Lana School of Public Health, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Joy MacDermid
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Physical Therapy, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
| | - Christina Ziebart
- Physical Therapy, Western University, London, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
| | - Eleni Boutsikari
- Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Attica, Greece
| | - Emily Lalone
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
- Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Louis Ferreira
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
- Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Ruby Grewal
- Roth McFarlane Hand and Upper Limb Centre, Western University, London, Ontario, Canada
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