Considerations for improving quality of care of patients with rheumatoid arthritis and associated comorbidities

OBJECTIVE

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder with a global prevalence of approximately 0.5-1%. Patients with RA are at an increased risk of developing comorbidities (eg, cardiovascular disease, pulmonary disease, diabetes and depression). Despite this, there are limited recommendations for the management and implementation of associated comorbidities. This study aimed to identify good practice interventions in the care of RA and associated comorbidities.

METHODS

A combination of primary research (180+ interviews with specialists across 12 European rheumatology centres) and secondary research (literature review of existing publications and guidelines/recommendations) were used to identify challenges in management and corresponding good practice interventions. Findings were prioritised and reviewed by a group of 18 rheumatology experts including rheumatologists, comorbidity experts, a patient representative and a highly specialised nurse.

RESULTS

Challenges throughout the patient pathway (including delays in diagnosis and referral, shortage of rheumatologists, limited awareness of primary care professionals) and 18 good practice interventions were identified in the study. The expert group segmented and prioritised interventions according to three distinct stages of the disease: (1) suspected RA, (2) recent diagnosis of RA and (3) established RA. Examples of good practice interventions included enabling self-management (self-monitoring and disease management support, for example, lifestyle adaptations); early arthritis clinic; rapid access to care (online referral, triage, ultrasound-guided diagnosis); dedicated comorbidity specialists; enhanced communication with primary care (hotline, education sessions); and integrating patient registries into daily clinical practice.

CONCLUSION

Learning from implementation of good practice interventions in centres across Europe provides an opportunity to more widely improved care for patients with RA and associated comorbidities.

Best-practice Indicators in Psoriatic Disease Care

OBJECTIVE

In 2016, members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), in collaboration with KPMG LLP (UK), conducted a study to measure care in psoriatic arthritis (PsA). A key finding was that centers do not usually have processes in place to measure the effect of improved quality of care. Our objectives were to identify and select best-practice indicators to enable PsA caregivers to assess and monitor the outcomes of specific initiatives aimed at improving care in 4 focus areas: (1) shortening time to diagnosis; (2) improving multidisciplinary collaboration; (3) optimizing disease management; and (4) improving disease monitoring.

METHODS

(1) Structured review of scientific and grey literature to obtain evidence for a long list of 100 potential indicators across the 4 focus areas; (2) survey expert rheumatologists and dermatologists to review the long list and identify the most meaningful and feasible indicators for use in day-to-day practice; (3) consensus discussion to identify a shortlist of indicators based on predefined selection criteria; (4) electronic group discussion to refine definitions of shortlisted indicators and targets; and (5) review of the shortlisted indicators at the annual GRAPPA meeting in July 2018 to ensure the indicators meet the preliminary criteria.

RESULTS

The expert group arrived at a consensus with a shortlist of 8 best-practice indicators across 4 key focus areas aligned with the patient pathway.

CONCLUSION

There were 8 evidence-based best-practice indicators and respective targets that were identified to enable the monitoring of quality of care and target improvements.

Benchmarking Care in Psoriatic Arthritis — The QUANTUM Report: A Report from the GRAPPA 2016 Annual Meeting

Members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), in partnership with KPMG LLP (UK), conducted interviews at selected research centers around the globe to analyze the process of care in psoriasis and psoriatic arthritis (PsA): pre-diagnosis, referral and diagnosis, treatment, and followup. Ten major challenges emerged, many of which were universally recognized across centers; the top 4 included limited awareness of PsA among non–rheumatologists, a disparate approach to care, late referral and diagnosis, and an inadequate management of comorbidities.

Effectiveness of chlorine, organic acids and UV treatments in reducing Escherichia coli O157:H7 and Yersinia enterocolitica on apples

This study assessed the effectiveness of 200 and 500 ppm of chlorine and organic acids (0.5% lactic acid and 0.5% citric acid) in wash solutions, and UV radiation for reducing Escherichia coli O157:H7 and Yersinia enterocolitica on apples contaminated by two different methods. Residual levels of these pathogens after different treatments were compared. On dip inoculated apples, Y. enterocolitica reductions of 2.66 and 2.77 logs were obtained with 200 and 500 ppm chlorine combined with 0.5% lactic acid, respectively. The E. coli O157:H7 population decreased 3.35 log with 0.5% lactic acid wash solution, and 2.72 and 2.62 logs after 500 ppm chlorine and 500 ppm chlorine plus 0.5% lactic acid treatments, respectively. Similar reductions were obtained with UV radiation. On spot inoculated apples, significant (p < 0.05) decreases of 4.67 and 4.58 logs were observed in E. coli O157:H7 and Y. enterocolitica levels, respectively, after 500 ppm chlorine plus 0.5% lactic acid treatment as compared with the control. In sectioned apples, microorganisms infiltrated in inner core region and pulp were not significantly (p < 0.05) affected by disinfection treatments. No pathogens were detected in the natural microflora on apples. Reductions such as those obtained with 500 ppm chlorine plus 0.5% lactic acid solution were very proximal to the 5-log score required by FDA for apple disinfection.