Elena Nikiphorou1, James Galloway2, Piet van Riel3, Yusuf Yazici4, Glenn Haugeberg5, Andrew Ostor6, Feride Gogus7, Markku Kauppi8, Tuulikki Sokka9. 1. Department of Rheumatology, Whittington Hospital, London, UK; and Jyväskylä Central Hospital, Rheumatology Unit, Jyväskylä, Finland. 2. King's College London, Academic Rheumatology Department, London, UK. 3. Department of Rheumatology, Bernhoven, Uden, The Netherlands. 4. NYU Hospital for Joint Diseases, New York, NY, USA. 5. Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway. 6. Department of Rheumatology, Addenbrookes Hospital, Cambridge, UK. 7. Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University, Faculty of Medicine, Ankara, Turkey. 8. Medical School, Tampere University, Tampere, Finland. 9. Jyväskylä Central Hospital, Rheumatology Unit, Jyväskylä, Finland. tuulikki.sokka-isler@ksshp.fi.
Abstract
OBJECTIVES: To explore patterns of real-world early RA (ERA) care across countries. METHODS: An online survey was disseminated to practising rheumatologists across Europe and the US, also made accessible on social media between April and May 2015. Survey questions (n=38) assessed the structure and setting of ERA clinics, times to diagnosis and treatment, patient monitoring, guideline use and data recording. RESULTS: A total of 212 rheumatologists from 39 countries (76% European) completed the survey. 62% had an ERA clinic based at a university hospital. Patient referral to rheumatology was mainly (78%) via primary care; 44% had an agreed ERA local referral pathway, 15% a national pathway. Only 16% had dedicated ERA clinics, the majority being practitioners in Northern Europe with access to a local or national referral pathway. Data for research were collected by 42%. Treatment guidelines were followed by the majority, especially rheumatologists practising in Europe. Variations existed in the use of initial DMARDs with treatment decisions reported to be influenced by international/national guidelines in 71%/61%. No significant relationship between country gross national income and the availability of ERA clinics was seen. CONCLUSIONS: This study provides comparative benchmark information regarding the global provision of ERA care. Substantial variations exist in referral and early assessment pathways with guidelines having a most apparent impact in Northern Europe. Provision of an ERA service does not appear to be constrained by cost, with conceptual factors, e.g. clinician engagement, perhaps playing a role. These initial insights could potentially help harmonise ERA management across countries.
OBJECTIVES: To explore patterns of real-world early RA (ERA) care across countries. METHODS: An online survey was disseminated to practising rheumatologists across Europe and the US, also made accessible on social media between April and May 2015. Survey questions (n=38) assessed the structure and setting of ERA clinics, times to diagnosis and treatment, patient monitoring, guideline use and data recording. RESULTS: A total of 212 rheumatologists from 39 countries (76% European) completed the survey. 62% had an ERA clinic based at a university hospital. Patient referral to rheumatology was mainly (78%) via primary care; 44% had an agreed ERA local referral pathway, 15% a national pathway. Only 16% had dedicated ERA clinics, the majority being practitioners in Northern Europe with access to a local or national referral pathway. Data for research were collected by 42%. Treatment guidelines were followed by the majority, especially rheumatologists practising in Europe. Variations existed in the use of initial DMARDs with treatment decisions reported to be influenced by international/national guidelines in 71%/61%. No significant relationship between country gross national income and the availability of ERA clinics was seen. CONCLUSIONS: This study provides comparative benchmark information regarding the global provision of ERA care. Substantial variations exist in referral and early assessment pathways with guidelines having a most apparent impact in Northern Europe. Provision of an ERA service does not appear to be constrained by cost, with conceptual factors, e.g. clinician engagement, perhaps playing a role. These initial insights could potentially help harmonise ERA management across countries.
Authors: András Inotai; Dominik Tomek; Maciej Niewada; László Lorenzovici; Martin Kolek; Jakub Weber; Anne-Katrin Kurrat; Emese Virág Kiss; Zoltán Kaló Journal: Front Pharmacol Date: 2020-06-05 Impact factor: 5.810