Background Despite being a sound treatment strategy, T2T still faces barriers to implementation.
Objectives To analyze the barriers to T2T implementation from patients perspective, including associations with socio-economic cultural background and disease activity status.
Methods A structured questionnaire addressing main points of T2T strategy was applied to 485 RA patients (1987 criteria) from private and public hospitals in different regions of Brazil, Importante points were repeated in different phrased questions. Social-economic-cultural status (Graffar scale), medication in use, demographic and disease activity data were collected. Association between categorical and continuous variables – mean (SD) – tested by ANOVA or Kruskal-Wallis, between categorical variables by Fisher or Fisher-Freeman-Halton (FFH); p<0,05.
Results Population: 485 patients, 89.7% female, age 52.3 (13,8) yrs, disease duration 11.5 (8.9) yrs, years of study 8.0 (5.2) yrs. Willingness to learn about RA and to share treatment decisions were prevalent, reported by more than 90% although only 64.1% actively searched for disease information. Higher social-economical levels (p=0.001), years of study (p=0.01), age (p=0.02), and private consultations (p=0,006) were significantly associated with active search of information. Desire to know the aim of the treatment (97.1% of the patients) was unrelated to any parameter studied. In general, the rheumatologist is source of information of about 80% of the patients and this search of information was associated with higher disease activity (p=0,012). Neither friends nor Brazilian Society of Rheumatology were routinely used as means of information about AR. Shared treatment decisions appealed to more than 90% of the patients unrelated to social-economic-cultural, private practice or RA activity. Knowledge of treatments, desire to discuss and share decisions, private practice were associated to use of biologics (p=0.04) but not DMARDs. Monthly consultations (while RA in high activity) were accepted by 84.3% of the patients and it was considered useful for disease activity control by 79%, althought male pacientes were less enthusiastic vs females (70 vs 86%), with 12,5% of them considering frequent visits of no use. Private or public service also affected the agreement with frequent visits (respectively 71.3 vs 89.9). Composite index of disease activity was considered useful by 64.3%, but negatively perceived by patients in private practice (33,1% considered their perception more accurate), however joint exam in all visits received 90% of approval and was considered useful for disease control by 71,6% of the patients, independently of age,sex, medication and socio-economic background.
Conclusions Patients barriers to T2T implementation are less prevalent than expected. Shared decisions and frequent disease activity evaluations were supported for most patients. Social-economic-cultural factors had a discrete impact. Unmet need was to provide information about RA outside the direct contact physitian-patient.
Disclosure of Interest None declared