Abstract
Aims: Disease modifying anti-rheumatic drugs (DMARDs) are prescribed to suppress disease activity and symptoms in people with inflammatory arthritis. This study aims to identify and synthesise qualitative evidence describing the factors influencing prescribing of DMARDs and other medicines) for inflammatory arthritis from the perspectives of clinicians (rheumatologists, nurses, pharmacists).
Methods: Inclusion criteria were 1) used qualitative or mixed methods for data collection and analysis; 2) rheumatologist, nurse or pharmacist perspectives; 3) prescription of any DMARDs ((conventional (cs), targeted synthetic (ts), biologic (b), biosimilars), glucocorticoids or analgesics used alone or in combination; and 4) in any healthcare setting in any country. Ovid MEDLINE and EMBASE and EBSCOhost CINAHL Plus were searched from inception to 25 November 2019. Two independent reviewers identified studies for inclusion, assessed methodological quality of individual studies using the Critical Appraisal Skills Programme (CASP) criteria, extracted data and conducted thematic synthesis. Confidence in synthesis findings was evaluated using GRADE Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual).
Results: Fifteen studies involving 716 clinicians (683 rheumatologists, 27 nurses and 6 hospital pharmacy managers) from The Netherlands, UK, Belgium, USA, Canada, Sweden, Portugal, and Iran were identified. Five findings were identified: Patients' preferences and characteristics; Rheumatologists’ knowledge, experience and approaches to treatment decision making; High demands on consultation time impeded time available to discuss medication options, benefits, risks, and cost; Restrictions with prescribing preferred medications for patients with RA due to treatment affordability for patients, patients’ insurance coverage, potential government reimbursement, and cost of medication; Recognition of the importance of providing patients with education regarding RA. Confidence ratings were either moderate or moderate-low for all themes.
Conclusion: The findings of this QES will inform strategies to support best practice prescribing and use of DMARDs and other medicines for inflammatory rheumatic conditions.
Methods: Inclusion criteria were 1) used qualitative or mixed methods for data collection and analysis; 2) rheumatologist, nurse or pharmacist perspectives; 3) prescription of any DMARDs ((conventional (cs), targeted synthetic (ts), biologic (b), biosimilars), glucocorticoids or analgesics used alone or in combination; and 4) in any healthcare setting in any country. Ovid MEDLINE and EMBASE and EBSCOhost CINAHL Plus were searched from inception to 25 November 2019. Two independent reviewers identified studies for inclusion, assessed methodological quality of individual studies using the Critical Appraisal Skills Programme (CASP) criteria, extracted data and conducted thematic synthesis. Confidence in synthesis findings was evaluated using GRADE Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual).
Results: Fifteen studies involving 716 clinicians (683 rheumatologists, 27 nurses and 6 hospital pharmacy managers) from The Netherlands, UK, Belgium, USA, Canada, Sweden, Portugal, and Iran were identified. Five findings were identified: Patients' preferences and characteristics; Rheumatologists’ knowledge, experience and approaches to treatment decision making; High demands on consultation time impeded time available to discuss medication options, benefits, risks, and cost; Restrictions with prescribing preferred medications for patients with RA due to treatment affordability for patients, patients’ insurance coverage, potential government reimbursement, and cost of medication; Recognition of the importance of providing patients with education regarding RA. Confidence ratings were either moderate or moderate-low for all themes.
Conclusion: The findings of this QES will inform strategies to support best practice prescribing and use of DMARDs and other medicines for inflammatory rheumatic conditions.
| Original language | English |
|---|---|
| Article number | ARA-113 |
| Pages (from-to) | 37 |
| Number of pages | 1 |
| Journal | Internal Medicine Journal |
| Volume | 50 |
| Issue number | S2 |
| DOIs | |
| Publication status | Published - Jul 2020 |
| Event | Australian Rheumatology Association Annual Scientific Meeting 2020 - virtual conference Duration: 16 May 2020 → 19 May 2020 Conference number: 60th https://onlinelibrary.wiley.com/toc/14455994/2020/50/S2 |