Highlights from

EULAR 2019

European Congress of Rheumatology

Madrid 12-15 June 2019

Gaps in rheumatoid arthritis care across Europe

In the reported study, important aspects of rheumatoid arthritis (RA) care gaps were identified, and differences across EU countries were observed. Patients identified gaps in standards of care (SoC) more frequently than rheumatologists. More than half of patients and rheumatologists reported ‘diagnosis within 6 weeks’ as the most problematic SoC [1].

The European Musculoskeletal Conditions Surveillance and Information Network (eumusc.net), is a EULAR- and EU-supported initiative that took place from 2008 to 2013. As part of eumusc.net, 16 user-focused SoC for RA were developed. Rachelle Meisters et al. (Maastricht University, the Netherlands) evaluated the gaps in quality of care using the eumusc.net SoC among patients and rheumatologists across Europe and investigated the contribution of individual- and country-level characteristics.

A total of 1,422 patients from 27 European countries and 1,044 rheumatologists from 33 European countries were included in the survey. Participants were asked to rate each SoC on the level of care that was achieved (1-10), and on level of importance (1-10). The distance of the level of care from the maximum was multiplied by the level of importance and a SoC was defined ‘problematic’ when this composite score was >30 and the importance score was ≥6. Individual- and country-level (based on gross domestic product) determinants of care gaps were predicted in multilevel logistic regression models, with patients clustered in country of residence. For patients, individual factors included gender, age, disease duration, level of education, work status, literacy, patient organisation membership, and overall health. For rheumatologists, individual factors were gender, age, years of experience, and work setting.

Results indicated 'diagnosis within 6 weeks' as the most concerning SoC, with 52% (weighted means across countries) of patients, and 59% of rheumatologists reporting critical RA care gaps. The next highest were: information about patient organisations (40% and 38%); training on aids, devices, and ergonomic principles (39% and 34%); vaccination-related information (38% and 27%); receiving a schedule of regular assessment (33% and 23%); information on adequate physical exercise (35% and 20%); and availability of treatment plan (35% and 18%). The least frequent problematic SoC for both patients (8%) and rheumatologists (3%) was ‘adequate disease-modifying anti-rheumatic drug received’. The data also indicated that patients with higher education and lower self-reported health report problematic gaps more frequently. Among rheumatologists, patterns in determinants across SoCs were less consistent.

"It is concerning to see so many problematic gaps reported across many essential aspects of RA care," concluded Meisters.

  1. Meisters R, et al. Abstract OP0307. EULAR 2019

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