THU0118 Patient-and physician-reported barriers to achieving rheumatoid arthritis (RA) disease control
Authors: M.I. Danila, L. Chen, R. O’Beirne, E.M. Ruderman, L.R. Harrold, J.A. Melnick, M.M. Safford, J.M. Kremer, J.R. Curtis
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Many patients with RA do not achieve guideline-recommended treat-to-target (T2T) goals in clinical practice. Little is known about the challenges that patients and rheumatologists face when attempting to achieve better control of RA disease activity. <h3>Objectives</h3> To identify and prioritise patient- and rheumatologist-perceived barriers to achieving RA disease activity control. <h3>Methods</h3> Participants were recruited from the Consortium of Rheumatology Researchers of North America (Corrona) registry and invited to participate in nominal groups (NGs), 4 with patients and 3 with rheumatologists. Each group generated a list of barriers to reaching RA disease control (patients) and T2T goals (rheumatologists). Two separate lists containing the generated items were created and were subjected to a card sort procedure to create common themes. A random sample of Corrona RA patients were invited by email to complete a compensated online survey and asked to rank their top 3 barriers. A weighted score was assigned for each barrier by considering the number of respondents who ranked it and the priority rank they assigned. The barriers/themes were sorted into domains. The patient survey also included knowledge items about T2T strategy and attitudes about RA treatment. <h3>Results</h3> Nominal groups with 37 RA patients identified 17 themes to achieving control of RA activity. Similarly, 8 themes emerged from the physician NGs, 7 of which were also found in the patient NGs (table 1). Cost of RA care was ranked highest by both patients and physicians, while medication risk aversion ranked second and third among the physician- and patient-generated barriers, respectively. We sent 1694 invitations to complete the survey and 450 patients with RA for whom clinical data was available responded within 3 weeks. There were no differences in age, sex, or disease duration between survey- respondents and non-respondents. A higher proportion of respondents were college-educated. A total of 344 (77%) respondents considered RA to be a high priority for their health, 225 (51%) reported being familiar with T2T as a treatment strategy, and 312 (85%) displayed core beliefs favouring medications. Among the challenges to controlling RA disease activity, the domain that received the highest score was unpredictability of RA and its treatment (figure 1). Symptoms and illness burden domain received the second highest score, followed by the health system factors domain (figure 1). <h3>Conclusions</h3> There are common patient- and physician-perceived barriers to achieving RA disease control. From the patient perspective important barriers are unpredictability of how RA may progress, medication risk aversion and cost of RA care. Addressing these barriers, when possible, may improve goal-directed RA care. <h3>Acknowledgements</h3> Pfizer IGLC, Corrona <h3>Disclosure of Interest</h3> None declared