Translating research into clinical practice: quality improvement to halve non-adherence to methotrexate.
Translating research into clinical practice: quality improvement to halve non-adherence to methotrexate.
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DOI：
10.1093/rheumatology/keaa214
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发表时间：
2021-01-05
期刊：
影响因子：
--
通讯作者：
Gorodkin R
中科院分区：
文献类型：
--
作者：
Barton A;Jani M;Bundy C;Bluett J;McDonald S;Keevil B;Dastagir F;Aris M;Bruce I;Ho P;McCarthy E;Bruce E;Parker B;Hyrich K;Gorodkin R
MTX 仍然是 RA 治疗的基石，但研究表明，不依从性很严重，并且与治疗反应相关。这项研究旨在将 Kellgren 风湿病中心自我报告的不遵守 MTX 的情况减少一半。在引入干预措施之前，我们制定了一份匿名自我报告依从性调查问卷并收集了 3 个月的数据，然后在接下来的 2.5 年里定期收集数据。实施了一系列干预措施，包括动机性访谈培训、有关 MTX 的一致信息以及总结书签的开发。收集有关诊所时间的信息，以进行有或没有动机访谈的咨询。进行调查以确定有关 MTX 的信息的一致性。使用生化检测在两个时间点测试患者的 MTX 血清水平：引入变化之前和引入变化后 2.8 年。从患者记录中检索 MTX 启动后 6 个月和 12 个月的缓解率，并通过将新生物制剂启动的实际数量与基于两个时间点雇用的顾问数量的预期数量进行比较来估计成本节省。 2016 年 6 月至 8 月期间，自我报告不遵守 MTX 的比例为 24.7%。引入干预措施后，2018 年 4 月至 2019 年 8 月期间，自我报告的不依从率平均下降至 7.4%。采用动机访谈时，门诊时间并未显着增加。工作人员在三个关键领域（MTX 的益处、饮酒指导和坚持的重要性）所传达信息的一致性从 2016 年 9 月的 64% 提高到 2018 年 1 月的 94%。生化不遵守率从 56%（2016 年 9 月）降低到 17%（2019 年 6 月），而开始使用 MTX 后 6 个月的缓解率从 2016 年的 13% 提高2014/15 年至 2017/18 年 37%，结果为 预计每年可节省 30 000 英镑的成本。可以通过简单的措施来改善 MTX 不依从性，包括关注治疗的依从性和益处，以及提供跨部门的一致信息。
MTX remains the cornerstone for therapy for RA, yet research shows that non-adherence is significant and correlates with response to therapy. This study aimed to halve self-reported non-adherence to MTX at the Kellgren Centre for Rheumatology. An anonymous self-report adherence questionnaire was developed and data collected for 3 months prior to the introduction of interventions, and then regularly for the subsequent 2.5 years. A series of interventions were implemented, including motivational interviewing training, consistent information about MTX and development of a summary bookmark. Information on clinic times was collected for consultations with and without motivational interviewing. Surveys were conducted to ascertain consistency of messages about MTX. A biochemical assay was used to test MTX serum levels in patients at two time points: before and 2.8 years following introduction of the changes. Remission rates at 6 and 12 months post-MTX initiation were retrieved from patient notes and cost savings estimated by comparing actual numbers of new biologic starters compared with expected numbers based on the numbers of consultants employed at the two time points. Between June and August 2016, self-reported non-adherence to MTX was 24.7%. Following introduction of the interventions, self-reported non-adherence rates reduced to an average of 7.4% between April 2018 and August 2019. Clinic times were not significantly increased when motivational interviewing was employed. Consistency of messages by staff across three key areas (benefits of MTX, alcohol guidance and importance of adherence) improved from 64% in September 2016 to 94% in January 2018. Biochemical non-adherence reduced from 56% (September 2016) to 17% (June 2019), whilst remission rates 6 months post-initiation of MTX improved from 13% in 2014/15 to 37% in 2017/18, resulting is estimated cost savings of £30 000 per year. Non-adherence to MTX can be improved using simple measures including focussing on the adherence and the benefits of treatment, and providing consistent information across departments.
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影响因子：
4.5
作者：
Eckmanns, Tim;Bessert, Jan;Rueden, Henning
通讯作者：
Rueden, Henning
影响因子：
6.2
作者：
Hope, Holly F.;Bluett, James;Verstappen, Suzanne M. M.
通讯作者：
Verstappen, Suzanne M. M.
影响因子：
13.3
作者：
Gwinnutt, James M.;Symmons, Deborah P. M.;Verstappen, Suzanne M. M.
通讯作者：
Verstappen, Suzanne M. M.
DOI：
10.1093/rheumatology/keu358
发表时间：
2015-03
期刊：
Rheumatology (Oxford, England)
影响因子：
--
作者：
Bluett J;Morgan C;Thurston L;Plant D;Hyrich KL;Morgan AW;Wilson AG;Isaacs JD;Cordingley L;Barton A;BRAGGSS
通讯作者：
BRAGGSS
影响因子：
4.9
作者：
Sergeant JC;Hyrich KL;Anderson J;Kopec-Harding K;Hope HF;Symmons DPM;RAMS Co-Investigators;Barton A;Verstappen SMM
通讯作者：
Verstappen SMM