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Practice what you preach? An exploratory multilevel study on rheumatoid arthritis guideline adherence by rheumatologists

OBJECTIVES: To assess variation in and determinants of rheumatologist guideline adherence in patients with rheumatoid arthritis (RA), in daily practice. METHODS: In this retrospective observational study, guideline adherence in the first year of treatment was assessed for 7 predefined parameters on...

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Autores principales: Lesuis, N, den Broeder, A A, Hulscher, M E J L, van Vollenhoven, R F
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879343/
https://www.ncbi.nlm.nih.gov/pubmed/27252892
http://dx.doi.org/10.1136/rmdopen-2015-000195
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author Lesuis, N
den Broeder, A A
Hulscher, M E J L
van Vollenhoven, R F
author_facet Lesuis, N
den Broeder, A A
Hulscher, M E J L
van Vollenhoven, R F
author_sort Lesuis, N
collection PubMed
description OBJECTIVES: To assess variation in and determinants of rheumatologist guideline adherence in patients with rheumatoid arthritis (RA), in daily practice. METHODS: In this retrospective observational study, guideline adherence in the first year of treatment was assessed for 7 predefined parameters on diagnostics, treatment and follow-up in all adult patients with RA with a first outpatient clinic visit at the study centre, from September 2009 to March 2011. Variation in guideline adherence was assessed on parameter and rheumatologist level. Determinants for guideline adherence were assessed in patients (demographic characteristics, rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide antibody (aCCP) positivity, erythrocyte sedimentation rate, erosive disease, comorbidity and the number of available disease modifying anti-rheumatic drug (DMARD) treatment options) and rheumatologists (demographic and practice characteristics, guideline knowledge and agreement, outcome expectancy, cognitive bias, thinking style, numeracy and personality). RESULTS: A total of 994 visits in 137 patients with RA were reviewed. Variation in guideline adherence among parameters was present (adherence between 21% and 72%), with referral to the physician assistant as lowest scoring and referral to a specialised nurse as highest scoring parameter. Variation in guideline adherence among rheumatologists was also present (adherence between 22% and 100%). Patient sex, the number of DMARD options, presence of erosions, comorbidity, RF/aCCP positivity, type of patient and the rheumatologists' scientific education status were associated with adherence to 1 or more guideline parameters. CONCLUSIONS: Guideline adherence varied considerably among the guideline parameters and rheumatologists, showing that there is room for improvement. Guideline adherence in our sample was related to several patient and rheumatologist determinants.
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spelling pubmed-48793432016-06-01 Practice what you preach? An exploratory multilevel study on rheumatoid arthritis guideline adherence by rheumatologists Lesuis, N den Broeder, A A Hulscher, M E J L van Vollenhoven, R F RMD Open Rheumatoid Arthritis OBJECTIVES: To assess variation in and determinants of rheumatologist guideline adherence in patients with rheumatoid arthritis (RA), in daily practice. METHODS: In this retrospective observational study, guideline adherence in the first year of treatment was assessed for 7 predefined parameters on diagnostics, treatment and follow-up in all adult patients with RA with a first outpatient clinic visit at the study centre, from September 2009 to March 2011. Variation in guideline adherence was assessed on parameter and rheumatologist level. Determinants for guideline adherence were assessed in patients (demographic characteristics, rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide antibody (aCCP) positivity, erythrocyte sedimentation rate, erosive disease, comorbidity and the number of available disease modifying anti-rheumatic drug (DMARD) treatment options) and rheumatologists (demographic and practice characteristics, guideline knowledge and agreement, outcome expectancy, cognitive bias, thinking style, numeracy and personality). RESULTS: A total of 994 visits in 137 patients with RA were reviewed. Variation in guideline adherence among parameters was present (adherence between 21% and 72%), with referral to the physician assistant as lowest scoring and referral to a specialised nurse as highest scoring parameter. Variation in guideline adherence among rheumatologists was also present (adherence between 22% and 100%). Patient sex, the number of DMARD options, presence of erosions, comorbidity, RF/aCCP positivity, type of patient and the rheumatologists' scientific education status were associated with adherence to 1 or more guideline parameters. CONCLUSIONS: Guideline adherence varied considerably among the guideline parameters and rheumatologists, showing that there is room for improvement. Guideline adherence in our sample was related to several patient and rheumatologist determinants. BMJ Publishing Group 2016-05-17 /pmc/articles/PMC4879343/ /pubmed/27252892 http://dx.doi.org/10.1136/rmdopen-2015-000195 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Rheumatoid Arthritis
Lesuis, N
den Broeder, A A
Hulscher, M E J L
van Vollenhoven, R F
Practice what you preach? An exploratory multilevel study on rheumatoid arthritis guideline adherence by rheumatologists
title Practice what you preach? An exploratory multilevel study on rheumatoid arthritis guideline adherence by rheumatologists
title_full Practice what you preach? An exploratory multilevel study on rheumatoid arthritis guideline adherence by rheumatologists
title_fullStr Practice what you preach? An exploratory multilevel study on rheumatoid arthritis guideline adherence by rheumatologists
title_full_unstemmed Practice what you preach? An exploratory multilevel study on rheumatoid arthritis guideline adherence by rheumatologists
title_short Practice what you preach? An exploratory multilevel study on rheumatoid arthritis guideline adherence by rheumatologists
title_sort practice what you preach? an exploratory multilevel study on rheumatoid arthritis guideline adherence by rheumatologists
topic Rheumatoid Arthritis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879343/
https://www.ncbi.nlm.nih.gov/pubmed/27252892
http://dx.doi.org/10.1136/rmdopen-2015-000195
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