Rheumatoid arthritis, guideline adherence
Conditions
Interventions
Intervention 1: education and feedback
- information on RA treatment strategies including general background information and feedback on current guideline adherence
(all clinicians)
Intervention 2: I
Sponsors
Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
Eligibility
Inclusion criteria
Inclusion criteria: Clinicians: - all clinicians allowed, by Dutch law, to prescribe rheumatologic medication working at the Sint Maartenskliniek during the study period Patients: - all adult RA patients treated at the outpatient clinic of the Sint Maartenskliniek by one of the included clinicians during the study period Clinicians will be randomized, not patients.
Exclusion criteria
Exclusion criteria: Clinicians: - refusal to sign informed consent Patients: - none
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| In order to assess the first study objective (effectiveness of the interventions) 13 specially developed guideline indicators will be measured for all the RA patients before and after the interventions. 1. DAS28 measurement done during the outpatient clinic visit, either by a rheumatologist or other relevant health care professional 2.X-rays of hands, feet and thorax, done at the correct moment according to the local guideline 3. Yearly assessment of functional status (Health Assessment Questionnaire) by either the rheumatologist of another health care professional 4. Prescription of conventional DMARDs and biological therapy according to the preferential order¢Ó, in case of initiation of a new DMARD or biological 5. Use or prescription of a concomitant DMARD in case of biological treatment with Adalimumab, Etanercept, Infliximab or Rituximab. 6. Therapy change in case of active disease (based on DAS28) 7. Biological dose reduction in case of stable low disease activity for ¡Ã 6 months 8. Referral to a specialized nurse within two weeks after the second outpatient clinic visit, in case of a new patient 9.Referral to or seen at the Clinimetric Centre 10. Referral to a Physician Assistant 11. Correct intervals between consecutive regular visits 12. A ¡®new patient letters¡¯ send to the general physician within two weeks after the second outpatient clinic visit 13. A ¡®control patient letters¡¯ send to the general physician within 18 months after the last letter | — |
Secondary
| Measure | Time frame |
|---|---|
| Possible predictive factors are derived from earlier studies done in our centre and all focus on individual clinician factors: - cognitive bias (Inventory of Cognitive Bias in Medicine; ICBM) - personality (Big Five Inventory; BFI) - thinking styles (Rational Experiental Inventory; REI) - demographics (age, gender) - work & training (years of experience as clinician, % patient contact, PhD) | — |
Contacts
Public ContactA.A. den Broeder
Sint Maartenskliniek
Outcome results
None listed