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Batko B, Batko K, Krzanowski M, et al. Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis. J Clin Med. 2019;8(9)doi: 10.3390/jcm8091416.
Batko, B., Batko, K., Krzanowski, M., & Żuber, Z. (2019). Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis. Journal of clinical medicine, 8(9), . https://doi.org/10.3390/jcm8091416
Batko, Bogdan, et al. "Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis." Journal of clinical medicine vol. 8,9 (2019). doi: https://doi.org/10.3390/jcm8091416
Batko B, Batko K, Krzanowski M, Żuber Z. Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis. J Clin Med. 2019 Sep 08;8(9). doi: 10.3390/jcm8091416. PMID: 31500394; PMCID: PMC6780913.
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J Clin Med. 2019 Sep 08;8(9). doi: 10.3390/jcm8091416.

Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis.

Journal of clinical medicine

Bogdan Batko, Krzysztof Batko, Marcin Krzanowski, Zbigniew Żuber

Affiliations

  1. Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Gustawa Herlinga-Grud?i?skiego 1 St, 30-705 Cracow, Poland. [email protected].
  2. Department of Rheumatology, J. Dietl Specialist Hospital, Skarbowa 1 St, 31-121 Cracow, Poland. [email protected].
  3. Chair and Head of Nephrology, Jagiellonian University Medical College, Kopernika St 15c, 31-501 Cracow, Poland. [email protected].
  4. Chair and Head of Nephrology, Jagiellonian University Medical College, Kopernika St 15c, 31-501 Cracow, Poland. [email protected].
  5. Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Gustawa Herlinga-Grud?i?skiego 1 St, 30-705 Cracow, Poland. [email protected].
  6. Ward for Older Children with Neurology and Rheumatology Subdivision, St. Louis Regional Specialised Children's Hospital, 31-503 Cracow, Poland. [email protected].

PMID: 31500394 PMCID: PMC6780913 DOI: 10.3390/jcm8091416

Abstract

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.

Keywords: arthritis; guideline adherence; physicians; physicians’; practice patterns; rheumatoid; rheumatologists; treat-to-target

Conflict of interest statement

The authors declare no conflict of interest.

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