在类风湿关节炎中实施靶向治疗的挑战:巴西风湿病学家的观点。

IF 2 4区 医学 Q3 RHEUMATOLOGY
Adriana Maria Kakehasi, Angela Luzia Branco Pinto Duarte, Claiton Viegas Brenol, Diogo Souza Domiciano, Ieda Maria Magalhães Laurindo, Karina Rossi Bonfiglioli, Licia Maria Henrique da Mota, Maya H Buch, Eduardo de Almeida Macêdo, Ricardo Machado Xavier
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引用次数: 0

摘要

背景:类风湿性关节炎(RA)的患者管理已发展为 "靶向治疗"(T2T)方法,包括强化治疗和定期随访,目标是实现低水平的疾病活动或临床缓解。尽管 T2T 方法得到了专业组织的认可,并取得了卓越的疗效,但其实施仍不彻底。EVEREST(EleVatE care in RhEumatoid arthritiS with Treat-to-target,类风湿性关节炎的靶向治疗)是一项质量改进计划,旨在改善个性化 T2T 策略的广泛实施,使 RA 患者充分发挥缓解的潜力。我们介绍了全球T2T调查(EVEREST计划的第一部分)在巴西的结果:2022年6月至9月,我们针对巴西的风湿免疫科医生进行了一次在线调查。我们的目标是评估阻碍有效实施 T2T 策略的障碍和知识差距。为此,我们专门设计了一组多项选择题,以引出按结构顺序分类的回答:166名风湿病学家参与了调查,其中51%的人拥有21年以上的风湿病学经验。关于在临床实践中管理 RA 所面临的挑战,参与者中同意/非常同意的最高比例与疾病活动度测量的矛盾结果有关(60%)。在临床实践中评估疾病活动性的主要障碍方面,分别有75%和59%的参与者表示,缺乏对治疗的依从性以及患者报告结果与综合测量结果之间的评估结果相互矛盾是中度/严重障碍。参与者最常指出的与RA管理相关的知识和技能差距是难以评估患者的健康素养(54%的参与者表示对标准化评估方法的了解不超过中等水平,43%的参与者表示对确定患者健康素养水平的技能不超过中等水平)。总体而言,参与者表示在临床实践中使用工具支持对RA患者的管理并不常见。他们指出,自我反思问卷、患者教育材料和治疗考虑清单是使用频率最低的工具(分别有85%、64%和62%的参与者表示从未使用、很少使用或仅偶尔使用):我们的研究结果表明,更有必要设计、选择和采用实用的策略,以进一步改善医疗服务提供者与 RA 患者之间的沟通,并促进患者在护理过程中做出知情的合作决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Challenges in implementing treat-to-target in rheumatoid arthritis: a perspective from Brazilian rheumatologists.

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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来源期刊
Advances in Rheumatology
Advances in Rheumatology Medicine-Rheumatology
CiteScore
4.00
自引率
4.30%
发文量
41
审稿时长
53 weeks
期刊介绍: Formerly named Revista Brasileira de Reumatologia, the journal is celebrating its 60th year of publication. Advances in Rheumatology is an international, open access journal publishing pre-clinical, translational and clinical studies on all aspects of paediatric and adult rheumatic diseases, including degenerative, inflammatory and autoimmune conditions. The journal is the official publication of the Brazilian Society of Rheumatology and welcomes original research (including systematic reviews and meta-analyses), literature reviews, guidelines and letters arising from published material.
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