Evaluación de la implementación de la estrategia “Treat to Target” en pacientes con artritis reumatoide en 8 centros de reumatología en Colombia después de un programa integral de difusión entre médicos

Pedro Sántos-Moreno, Maria José Jannaut Peña, Guillermo Sánchez, Carlo Caballero, Ingrid Rodríguez

Resumen


Objetivo: Establecer el grado de adherencia a la estrategia T2T, antes y después de la implementación de un programa integral de difusión (PID), entre un grupo de reumatólogos en los principales centros de referencia colombianos.

Metodología: Se llevó a cabo un estudio analítico de antes y después.

La evaluación de adherencia incluyó: verificación del conteo articular, aplicación del DAS 28, tratamiento y seguimiento basado en los resultados del DAS 28. Se llevó a cabo una medición basal, se realizó el PID de la estrategia T2T en todos los centros y se practicó una medición de seguimiento al mes 12.

Resultados: Se evaluaron 681 casos en la medición basal, 676 a los 12 meses. La medición del conteo articular disminuyó del 84% al 81% (valor p:0,064); la medición del DAS 28 pasó del 24,5% al 31% (p:0,0001); la conducta terapéutica adecuada pasó del 24% al 31% (p:0,006); el seguimiento basado en DAS 28 pasó del 19% al 26% (p:0,002) y el nivel de adherencia basal que fue del 19% pasó al 26% en el mes 12 (p:0,002).

Conclusión: El nivel de adherencia basal al T2T entre los centros de estudio fue muy bajo. La estrategia de difusión integral, permitió mejorar los resultados de adherencia al T2T en una evaluación a 12 meses, sin embargo los resultados no son satisfactorios. Se deben proponer e implementar nuevas acciones encaminadas a mejorar la adherencia al T2T.

 

 Evaluation of the implementation of the strategy "Treatments by objectives" in patients with rheumatoid arthritis in 8 rheumatology centers in Colombia after a comprehensive program of outreach to doctors.

 

ABSTRACT

Objective: To establish the degree of adherence to the “Treat to target” strategy of rheumatologists in referral centers in Colombia, before and after of implementation a comprehensive dissemination program (PID).                                                                                                                                         Methods: An analytical study was performed. Assessment of adherence included: joint count verification, application of 28 DAS, treatment and monitoring based on the results of the DAS 28. Baseline measurement was performed, the PID of the T2T strategy was applied in all centers and a follow up at month 12 was performed.                                                                                 Results: 681 cases were evaluated at baseline, 676 cases 12 months after. Measuring joint count decreased from 84% to 81% (p-value: 0.064); using of DAS28 increased from 24.5% to 31%(p = 0.0001); defined adequate treatment increased from 24% to 31% (p = 0.006); defined adequate monitoring increased from 19% to 26% (p = 0.002) and the level of physician’s adherence increased from a basal 19% to 26% at month 12 (p = 0.002).  Conclusions: The level of baseline adherence to T2T between study centers is very low. Comprehensive dissemination strategy used led to improve adherence to T2T at month 12.

Key words: Rheumatoid arthritis; therapy, prescription compliment, treatment result.


Texto completo:

[PDF]

Referencias


Emery P, Breedveld FC, Hall S, Durez P, Chang DJ, Robertson D, et al. Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. Lancet. 2008;372(9636):375-82.

Smolen JS, Aletaha D, Koeller M, Weisman MH, Emery P. New therapies for treatment of rheumatoid arthritis. Lancet. 2007;370(9602):1861-74.

van Gestel AM, Haagsma CJ, van Riel PL. Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum. 1998;41(10):1845-50.

Aletaha D, Smolen JS. The definition and measurement of disease modification in inflammatory rheumatic diseases. Rheum Dis Clin North Am. 2006;32(1):9-44, vii.

Smolen JS, Breedveld FC, Schiff MH, Kalden JR, Emery P, Eberl G, et al. A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology (Oxford). 2003;42(2):244-57.

Pincus T, Yazici Y, Bergman M, Maclean R, Harrington T. A proposed continuous quality improvement approach to assessment and management of patients with rheumatoid arthritis without formal joint counts, based on quantitative routine assessment of patient index data (RAPID) scores on a multidimensional health assessment questionnaire (MDHAQ). Best Pract Res Clin Rheumatol. 2007;21(4):789-804.

Schoels M, Aletaha D, Smolen JS, Bijlsma JW, Burmester G, Breedveld FC, et al. Follow-up standards and treatment targets in rheumatoid arthritis: results of a questionnaire at the EULAR 2008. Ann Rheum Dis. 2010;69(3):575-8.

Mierau M, Schoels M, Gonda G, Fuchs J, Aletaha D, Smolen JS. Assessing remission in clinical practice. Rheumatology (Oxford). 2007;46(6):975-9.

Sokka T, Hetland ML, Makinen H, Kautiainen H, Horslev-Petersen K, Luukkainen RK, et al. Remission and rheumatoid arthritis: data on patients receiving usual care in twenty-four countries. Arthritis Rheum. 2008;58(9):2642-51.

Smolen JS, Han C, van der Heijde DM, Emery P, Bathon JM, Keystone E, et al. Radiographic changes in rheumatoid arthritis patients attaining different disease activity states with methotrexate monotherapy and infliximab plus methotrexate: the impacts of remission and tumour necrosis factor blockade. Ann Rheum Dis. 2009;68(6):823-7.

Lard LR, Visser H, Speyer I, vander Horst-Bruinsma IE, Zwinderman AH, Breedveld FC, et al. Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med. 2001;111(6):446-51.

Nell VP, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford). 2004;43(7):906-14.

Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69(4):631-7.

Haraoui B, Smolen JS, Aletaha D, Breedveld FC, Burmester G, Codreanu C, et al. Treating Rheumatoid Arthritis to Target: multinational recommendations assessment questionnaire. Ann Rheum Dis. 2011.

Kahn HA, Sempos CT. Statistical methods in epidemiology. New York: Oxford University Press; 1989. xiii, 292 p. p.

Grigor C, Capell H, Stirling A, McMahon AD, Lock P, Vallance R, et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet. 2004;364(9430):263-9.

Hetland ML, Horslev-Petersen K. The CIMESTRA study: intra-articular glucocorticosteroids and synthetic DMARDs in a treat-to-target strategy in early rheumatoid arhtritis. Clin Exp Rheumatol. 2012;30(4 Suppl 73):S44-9.

Vermeer M, Kuper HH, Bernelot Moens HJ, Hoekstra M, Posthumus MD, van Riel PL, et al. Adherence to a treat-to-target strategy in early rheumatoid arthritis: results of the DREAM remission induction cohort. Arthritis Res Ther. 2012;14(6):R254.

Caporali R, Conti F, Covelli M, Govoni M, Salaffi F, Ventriglia G, et al. Treating rheumatoid arthritis to target: an Italian rheumatologists' survey on the acceptance of the treat-to-target recommendations. Clin Exp Rheumatol. 2014;32(4):471-6.

Vermeer M, Kuper HH, Moens HJ, Drossaers-Bakker KW, van der Bijl AE, van Riel PL, et al. Sustained beneficial effects of a protocolized treat-to-target strategy in very early rheumatoid arthritis: three-year results of the Dutch Rheumatoid Arthritis Monitoring remission induction cohort. Arthritis Care Res (Hoboken). 2013;65(8):1219-26.

Park YB, Koh EM, Kim HY, Park SH, Park W, Bae SC, et al. Treating rheumatoid arthritis to target: recommendations assessment questionnaire in Korea. Clin Rheumatol. 2013;32(12):1791-7.

Haraoui B, Bensen W, Bessette L, Le Clercq S, Thorne C, Wade J. Treating rheumatoid arthritis to target: a Canadian physician survey. J Rheumatol. 2012;39(5):949-53.


Enlaces refback

  • No hay ningún enlace refback.


Académia Panameña de Medicina y Cirugía. Derechos reservados 2013. Un servicio de Infomedic International S,A.