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Mixed methods study of clinicians’ perspectives on barriers to implementation of treat to target in psoriatic arthritis
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Dures, Emma, Taylor, Julie, Shepperd, Sasha, Mukherjee, Sandeep, Robson, Joanna, Vlaev, Ivo, Walsh, Nicola and Coates, Laura C. (2020) Mixed methods study of clinicians’ perspectives on barriers to implementation of treat to target in psoriatic arthritis. Annals of the Rheumatic Diseases, 79 (8). pp. 1031-1036. doi:10.1136/annrheumdis-2020-217301 ISSN 0003-4967.
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WRAP-Mixed-methods-study-clinicians-perspectives-barriers-implementation-Vlaev-2020.pdf - Accepted Version - Requires a PDF viewer. Download (715Kb) | Preview |
Official URL: https://doi.org/10.1136/annrheumdis-2020-217301
Abstract
Objectives: In treat to target (T2T), the patient is treated to reach and maintain specified and sequentially measured goals, such as remission or low disease activity. T2T in psoriatic arthritis (PsA) has demonstrated improved clinical and patient-reported outcomes and is recommended in European guidelines. However, most clinicians do not use T2T in PsA. This study examined the barriers and enablers to implementation in practice. Methods: Sequential mixed methods comprising a qualitative design (interviews and focus group) to inform a quantitative design (survey). Qualitative data were analysed thematically, and quantitative statistics were analysed descriptively. Results: Nineteen rheumatology clinicians participated in telephone interviews or a face-to-face focus group. An overarching theme ‘Complexity’ (including ‘PsA vs Rheumatoid Arthritis’, ‘Measurement’ and ‘Resources’) and an underpinning theme ‘Changes to current practice’ (including ‘Reluctance due to organisational factors’ and ‘Individual determination to make changes’) were identified. 153 rheumatology clinicians responded to an online survey. Barriers included limited clinical appointment time to collect outcome data (54.5%) and lack of training in assessing skin disease (35%). Enablers included provision of a protocol (86.4%), a local implementation lead (80.9%), support in clinic to measure outcomes (83.3%) and training in T2T (69.8%). The importance of regular audit with feedback, specialist PsA clinics and a web-based electronic database linked to hospital/national information technology (IT) systems were also identified as enablers. Conclusions: Implementation of T2T in PsA requires an integrated approach to address the support, training and resource needs of individual clinicians, rheumatology teams, local IT systems and service providers to maximise success.
Item Type: | Journal Article | ||||||||||||||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||||||||||||||
Divisions: | Faculty of Social Sciences > Warwick Business School | ||||||||||||||||||
SWORD Depositor: | Library Publications Router | ||||||||||||||||||
Library of Congress Subject Headings (LCSH): | Psoriatic arthritis | ||||||||||||||||||
Journal or Publication Title: | Annals of the Rheumatic Diseases | ||||||||||||||||||
Publisher: | BMJ Group | ||||||||||||||||||
ISSN: | 0003-4967 | ||||||||||||||||||
Official Date: | 13 June 2020 | ||||||||||||||||||
Dates: |
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Volume: | 79 | ||||||||||||||||||
Number: | 8 | ||||||||||||||||||
Page Range: | pp. 1031-1036 | ||||||||||||||||||
DOI: | 10.1136/annrheumdis-2020-217301 | ||||||||||||||||||
Status: | Peer Reviewed | ||||||||||||||||||
Publication Status: | Published | ||||||||||||||||||
Reuse Statement (publisher, data, author rights): | “This article has been accepted for publication in Annals of the Rheumatic Diseases, 2020 following peer review, and the Version of Record can be accessed online at https://doi.org/10.1136/annrheumdis-2020-217301 “Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) http://creativecommons.org | ||||||||||||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||||||||||||
Copyright Holders: | © Author(s) (or their employer(s)) 2020 | ||||||||||||||||||
Date of first compliant deposit: | 18 June 2020 | ||||||||||||||||||
Date of first compliant Open Access: | 24 June 2020 | ||||||||||||||||||
RIOXX Funder/Project Grant: |
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