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30-10-2011 | Immunology | Article

Factors affecting care decisions in RA differ among physicians, patients


Free abstract

MedWire News: Patients with rheumatoid arthritis (RA) and rheumatologists consider different factors when taking the decision to escalate care, a study shows, suggesting that better communication may improve treatment planning in patients with active disease.

"These differences might explain why guidelines to achieve and maintain tight control of disease activity are frequently not adhered to," say Laura van Hulst (Radboud University Nijmegen Medical Center, the Netherlands) and co-authors.

The researchers administered a Maximum Difference Scaling survey, which includes 58 factors relating to the decision to escalate care in RA, to 106 rheumatologists and 213 patients with the condition. Participants answered 24 questions, with the most important factor identified from a set of five. Statistical modeling was then used to generate the mean relative importance score (RIS) for each factor.

Patients were aged on average 60.0 years, and had a median 7-year disease duration with a mean numerical rating scale disease activity score of 5.3 in the past week. The majority of patients (63.4%) were on monotherapy and had been prescribed methotrexate.

Rheumatologists were aged 47.2 years on average and had 15.2 years of experience in the field. In total, 92.5% spent the majority of their time in patient care.

Analysis of survey data showed that rheumatologists' decision-making was most strongly influenced by objective measures of disease activity, such as the number of swollen joints, DAS28 score, impression of overall disease activity, worsening erosions in the past year, and disease activity now compared with 3 months ago (mean RIS scores=5.24, 5.19, 5.17, 5.15, and 5.12, respectively).

On the other hand, patients' decision-making was mainly influenced by factors such as physical functioning and mobility, motivation to get better, trust in their physician, current satisfaction with medication, and painful joints (mean RIS scores=4.30, 3.55, 3.46, 3.41, and 3.37, respectively).

When the researchers analyzed the differences between patients and rheumatologists, they found that trust in the physician and level of comfort in expressing concerns were far more important for patients compared with rheumatologists (mean difference=3.09 and 2.56, respectively).

By contrast, prognostic features for RA and objective disease activity features were more important to rheumatologists.

Only the current level of physical function and mobility and physician impression of overall active disease were included among both patients' and physicians' top 10 factors.

"Further research is need to determine if decision aids can help patients and physicians better communicate about the decision to escalate care in order to achieve and maintain tight control in RA," conclude the authors in the journal Arthritis Care and Research.

By Ingrid Grasmo

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