Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Novel Learning Model Improves Documentation in RA

Key clinical point: A non-randomized study suggests implementation of a learning collaborative model provides a modest influence on rheumatologist documentation of treat-to-target in rheumatoid arthritis (RA).

Major finding: Treat-to-target implementation scores were higher among intervention rheumatologists, compared with study controls (44.6% vs. 32.2%; P less than .01).

Study details: A non-randomized, interrupted time-series study of 554 patients with RA.

Disclosures: The study was funded by Pfizer. One author reported financial affiliations with AbbVie, Amgen, Genentech, Janssen, and Pfizer.

Citation:

Desai S et al. Arthritis Care Res. 2019 Nov 23. doi: 10.1002/acr.24114.

Commentary:

A treat-to-target approach in patients with RA is widely accepted to be the standard of care for achieving low disease activity, or remission, and to prevent joint damage. However, objective disease activity measurement tools have low adoption rates in clinical practice, raising the question of how best to improve utilization and documentation of these tools. The study authors looked at the use of a learning collaborative intervention, compared with no educational intervention, in rheumatologists at a single center. All RA patients in the study completed RAPID3 scores prior to their visit. As expected, rheumatologists who received the intervention were more likely to document use of a disease activity score and shared decision-making. However, interestingly, those who had received the intervention were less likely to document change in medications in patients with high RAPID3 scores, which the authors suggest may be related to comorbidities complicating the use of other drugs and perception of medication effectiveness. This latter point suggests that perhaps practitioners did not understand or believe the results of the objective disease activity scores, so the educational tool should be examined prior to full implementation.— Arundathi Jayatilleke, MD