Qualitative assessment of the impact of restricting number of drug treatments for rheumatoid arthritis: Experience of prescribers and patients.

IF 1.5 Q3 RHEUMATOLOGY
Musculoskeletal Care Pub Date : 2023-12-01 Epub Date: 2023-11-02 DOI:10.1002/msc.1838
David Walker, Sandra Robinson
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引用次数: 0

Abstract

Introduction: In 2020, almost half of all Clinical Commissioning Groups in England were restricting the number of higher cost drugs (HCDs) that could be prescribed for Rheumatoid Arthritis (RA) before an Individual Funding Request was required. We were interested in qualitatively exploring the experiences of prescribers affected by these restrictions and the experiences of patients who required four or more of these drugs.

Methods: Semi-structured interviews were conducted with five prescribers in restricted areas and six patients from our own service who had received four or more HCDs. The interviews were analysed thematically.

Results: Prescribers reported feeling distressed and frustrated by the unsatisfactory service they were constrained to provide. Some prescribers continued partially effective treatments in order not to run out of options. They did not find Individual Funding Requests or the Blueteq High Cost Drug (HCD) System helpful in the management of these patients. The Blueteq HCD System is an electronic platform that allows health managers to monitor the prescribing of high-cost medicines and manage the complexities associated with their use. Patients expressed severe distress at the prospect of running out of options and anxiety around the process of gaining approval for their next treatment.

Conclusions: Restricting drugs for RA by the number which can be prescribed results in persistence with partially effective treatments, which is unsatisfactory for prescribers and patients, further it does not save money. Patients need to travel in their journey with RA and be able to try the next drug even though they know that it may not work.

限制类风湿性关节炎药物治疗次数影响的定性评估:处方医生和患者的经验。
引言:2020年,在需要个人资金申请之前,英格兰几乎一半的临床调试小组都在限制治疗类风湿性关节炎(RA)的高成本药物(HCD)的数量。我们感兴趣的是定性地探索受这些限制影响的处方医生的经历,以及需要四种或四种以上这些药物的患者的经历。方法:对五名限制区的处方医生和六名接受过四次或四次以上HCD的患者进行半结构化访谈。访谈按主题进行了分析。结果:处方医生报告说,他们对被迫提供的不令人满意的服务感到痛苦和沮丧。一些开处方的人继续进行部分有效的治疗,以免失去选择。他们没有发现个人资助申请或Blueteq高成本药物(HCD)系统对这些患者的管理有帮助。Blueteq HCD系统是一个电子平台,允许卫生管理人员监控高成本药物的处方,并管理与使用相关的复杂性。患者对下一次治疗获得批准的过程中可能会失去选择和焦虑表示严重的痛苦。结论:通过处方数量限制治疗RA的药物会导致部分有效治疗的持续性,这对处方医生和患者来说是不令人满意的,而且也不能节省资金。RA患者需要在旅途中旅行,并能够尝试下一种药物,即使他们知道它可能不起作用。
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来源期刊
Musculoskeletal Care
Musculoskeletal Care RHEUMATOLOGY-
CiteScore
2.30
自引率
7.70%
发文量
88
期刊介绍: Musculoskeletal Care is a peer-reviewed journal for all health professionals committed to the clinical delivery of high quality care for people with musculoskeletal conditions and providing knowledge to support decision making by professionals, patients and policy makers. This journal publishes papers on original research, applied research, review articles and clinical guidelines. Regular topics include patient education, psychological and social impact, patient experiences of health care, clinical up dates and the effectiveness of therapy.
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