Real-Time Feedback on Treatment Satisfaction May Improve Treat-to-Target Approach in RA

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Real-time patient input about treatment satisfaction can improve management strategies in patients with rheumatoid arthritis.

The following article is part of conference coverage from the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago, Illinois. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from ACR/ARHP 2018 .

CHICAGO – Real-time patient input about treatment satisfaction can improve treat-to-target strategies among patients with rheumatoid arthritis (RA), according to data presented at the 2018 ACR/ARHP Annual Meeting, held October 19-24, in Chicago, Illinois.1

Investigators from Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, implemented a treat-to-target approach for medication optimization for patients with RA. They collected disease activity scores using iPad tablets in the waiting room and conducted a non-randomized, quality improvement study to determine the success of their implementations.

A total of 2549 patients with RA completed a Routine Assessment of Patient Index Data 3 (RAPID3) survey between May 2017 and May 2018 using either a tablet or online patient portal. The scores from the survey were then uploaded to patient electronic medical record charts in real-time, and they were available for their physicians to review during the office visit.

Rheumatologists were assigned to an intervention (n=9) or control (n=13) group. Rheumatologists in the intervention group attended monthly sessions between August 2017 and September 2018 to discuss and develop treat-to-target strategies to use during office visits.

Physician notes were retrospectively analyzed by 2 researchers to identify patients with medication changes and to calculate treat-to-target scores. Phone calls were made to patients of rheumatologists in the intervention group following a medication change to measure treatment satisfaction using the Treatment Satisfaction Questionnaire for Medication (TSQM).

Researchers also measured shared decision making using the 9-item Shared Decision Making Questionnaire (SDM-Q-9). Both questionnaires used a 100-point scale, with higher numbers reflecting positive scores.

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Preliminary data revealed that treat-to-target scores among the intervention group were 15% higher than the control group. Of the 104 phone calls made to patients in the intervention group, median TSQM scores were 89 for convenience, 85 for side effects, 77 for global satisfaction, and 73 for effectiveness. The median SDM-Q-9 score was 91 for the patients in the intervention group.

“One of the strongest characteristics of our study is that it is based on a real-life clinic model, and reflects our experience in an everyday setting,” stated study coauthor Cianna Leatherwood, MD, rheumatologist at Kaiser Permanente Oakland Medical Center.2

“We hope that our experience can exemplify that it is possible to pursue routine implementation of patient-reported outcome measures into daily clinical practice. We were able to achieve buy-in at all levels of our clinic staff, including the front desk personnel, medical assistants and clinic management. This was an essential part of incorporating the surveys into routine workflow. Additionally, we learned from initial patient focus groups that shared decision-making was an important facet of RA management and medication adherence.”

For more coverage of ACR/ARHP 2018, click here.


  1. Forman M, Leatherwood C, Xu C, et al. Implementation of a treat-to-target quality improvement program for rheumatoid arthritis management using real-time patient reported outcome measures. Presented at: ACR/ARHP 2018 Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract 326.
  2. Real-time patient input on treatment satisfaction enhances treat-to-target RA management [press release]. Chicago, IL: American College of Rheumatology. Published October 20, 2018. Accessed October 20, 2018.

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