OBJECTIVE: Treat-to-target implementation in rheumatoid arthritis (RA) requires a shared decision-making (SDM) process. However, ability to pay is a major determinant of patient choice, but how this factor affects SDM is under-explored. METHODS: Visits at 4 RA clinics during which patients faced a decision to change their treatment were audiotaped between May 2016 and June 2017. Audiotapes were transcribed verbatim and analyzed using qualitative framework analysis. RESULTS: A total of 156 visits were analyzed. Most patients with RA, except those with effective insurance coverage, had deliberations disrupted or sidelined by third-party insurance providers having power to authorize the preferred disease-modifying antirheumatic drug choice. This triangulated SDM complicated efficiency in deliberations and timely treatment and was a barrier to shared engagement about health risks and symptom improvement typically found in patient-provider dyads. CONCLUSION: Rheumatology care providers should aim to incorporate treatment costs and ability to pay into their deliberations so that individualized out-of-pocket estimates can be considered during triangulated SDM at the point-of-care.
OBJECTIVE: Treat-to-target implementation in rheumatoid arthritis (RA) requires a shared decision-making (SDM) process. However, ability to pay is a major determinant of patient choice, but how this factor affects SDM is under-explored. METHODS: Visits at 4 RA clinics during which patients faced a decision to change their treatment were audiotaped between May 2016 and June 2017. Audiotapes were transcribed verbatim and analyzed using qualitative framework analysis. RESULTS: A total of 156 visits were analyzed. Most patients with RA, except those with effective insurance coverage, had deliberations disrupted or sidelined by third-party insurance providers having power to authorize the preferred disease-modifying antirheumatic drug choice. This triangulated SDM complicated efficiency in deliberations and timely treatment and was a barrier to shared engagement about health risks and symptom improvement typically found in patient-provider dyads. CONCLUSION: Rheumatology care providers should aim to incorporate treatment costs and ability to pay into their deliberations so that individualized out-of-pocket estimates can be considered during triangulated SDM at the point-of-care.
Authors: Natalia Mena-Vazquez; Sara Manrique-Arija; Lucía Yunquera-Romero; Inmaculada Ureña-Garnica; Marta Rojas-Gimenez; Carla Domic; Francisco Gabriel Jimenez-Nuñez; Antonio Fernandez-Nebro Journal: Rheumatol Int Date: 2017-06-19 Impact factor: 2.631
Authors: Leslie R Harrold; George W Reed; Ani John; Christine J Barr; Kevin Soe; Robert Magner; Katherine C Saunders; Eric M Ruderman; Tmirah Haselkorn; Jeffrey D Greenberg; Allan Gibofsky; J Timothy Harrington; Joel M Kremer Journal: Arthritis Care Res (Hoboken) Date: 2018-02-06 Impact factor: 4.794
Authors: René Lindholm Cordtz; Samuel Hawley; Daniel Prieto-Alhambra; Pil Højgaard; Kristian Zobbe; Søren Overgaard; Anders Odgaard; Lars Erik Kristensen; Lene Dreyer Journal: Ann Rheum Dis Date: 2017-12-15 Impact factor: 19.103