Dissemination and evaluation of the ASAS/EULAR recommendations for the management of Ankylosing Spondylitis: results of a study among 1,507 rheumatologists

Laure Gossec ^1*, Maxime Dougados ¹, Charles Phillips ², Mohammed Hammoudeh ³, Kurt de Vlam ⁴, Karel Pavelka ⁵, Thao Pham ⁶, Juergen Braun ⁷, Joachim Sieper ⁸, Ignazio Olivieri ⁹, Désirée van der Heijde ¹⁰, Eduardo Collantes ¹¹, Millicent A Stone ¹² and Tore K Kvien ¹³

¹ Paris Descartes University, France
² Wyeth Europa, United Kingdom
³ Hamad Medical corporation, Doha, Qatar
⁴ University Hospital Leuven, Belgium
⁵ Charles University, Prague, Czech Republic
⁶ Conception Hospital, AP-HM, Marseille, France
⁷ Rheumazentrum Ruhrgebiet, Germany
⁸ Medical Department I, Charité, Campus Benjamin Franklin, Berlin, Germany
⁹ San Carlo Hospital of Potenza and Madonna delle Grazie Hospital, Italy
¹⁰ University Medical Center, Leiden, Netherlands
¹¹ University Hospital Reina Sofía. Cordoba, Spain
¹² University of Bath and University of Toronto, United Kingdom
¹³ Diakonhjemmet Hospital, Oslo, Norway

^* To whom correspondence should be addressed. E-mail: laure.gossec{at}cch.aphp.fr.

Accepted 13 October 2007

Abstract

Background: Ten ASAS/EULAR recommendations for the management of ankylosing spondylitis (AS) were published in 2006. The objectives of this study were (a) to disseminate and (b) to evaluate conceptual agreement with, and (c) application of, these recommendations as well as (d) potential barriers to the application.

Methods: A questionnaire was sent out to rheumatologists in 10 countries. The questionnaire included (a) the text of the recommendations; (b) rheumatologists’ demographic variables; (c) 2 numerical rating scales (NRS) from 1 to 10 for each recommendation: conceptual agreement with, and application of, the recommendation (10 indicates maximal agreement and maximal application); and (d) a list of potential barriers to the application of the recommendation. Statistical analysis included descriptive and multivariate analyses.

Results: A total of 7206 questionnaires were sent out; 1507 (21%) were returned. Of the 1507 answering rheumatologists, 62% were men, mean age 49±9 yrs, and 34% had an academic position. Conceptual agreement with the recommendations was high (mean±SD for all recommendations 8.9±0.9). Self-reported application was also high (8.2±1.0). The difference between agreement and application varied across recommendations and countries. The most pronounced discrepancies were reported for use of anti-TNF drugs in a few countries with funding as the most frequently reported barrier for application of this recommendation.

Conclusion: This large project has helped the dissemination of the ASAS/EULAR recommendations for the management of AS and shows that conceptual agreement with the recommendations is very high. The project also highlights inequalities in access to health care for European citizens with AS.

Keywords: Ankylosing spondylitis,, dissemination,, evaluation,, implementation, recommendations,

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