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Measureable Benefits to Treat-to-Target Management in RA

Feb 24, 2021 7:35 pm

Desai and colleagues have published that when a learning collaborative group focused on a treat‐to‐target approach was compared to usual care, a modest but significant impact on implementation, treatment changes and patient outcomes in rheumatoid arthritis (RA) patients managed with a treat‐to‐target approach was seen.

These researchers took a quality improvement approach, with the intent of integrating a treat‐to‐target (TTT) approach into RA care and assessing its impact against a parallel cohort receiving usual care.

RA patients were clinically assessed using the patient‐reported outcome measure, RAPID3 (Routine Assessment of Patient Index Data 3) at clinic entry.  The intervention group included 9 rheumatologists and their patients were allocated to a learning collaborative intervention group focused on a treat‐to‐target approach. These rheumatologists were subjected to 9 learning sessions (1‐hour meetings) devoted to TTT (benefits, implementation and outcomes). This group was electronically reminded of these measures and their performance using TTT in clinical care.

The control group included 13 rheumatologists and their patients receiving usual, non-protcolized, care. The primary outcome was documentation of a treat‐to‐target implementation score: disease activity score, disease activity score used in the medication change decision, the presence of a treatment target, and an indication of shared decision‐making.

Overall the analysis included 554 individual rheumatology patients with 709 patient visits. After a perio of ___ weeks the primary outcomes are shown below:

  TTT Group Control Group P Value
TTT Implementation Scores 44.6% 32.2% P < 0.0001
DAS present 77.2% 68% P = 0.02
DAS for Medication Change 45.2% 30% P < 0.01
Shared Decision Making 46.9% 30% P < 0.01

When analyzing patients with high RAPID3 scores, they found medication changes were 54% less likely in the TTT versus control group (odds ratio 0.46 [95% confidence interval 0.27–0.79], P = 0.005).

This nonrandomized, interrupted time‐series trial demonstrated a modest but significant impact of a learning collaborative intervention on rheumatologist documentation of a treat‐to‐target approach in RA.

The author has no conflicts of interest to disclose related to this subject

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