Virtual Learning Collaborative Program May Improve Implementation of Treat-to-Target Approach in RA

Seniors asking a medication question via telemedicine
Researchers evaluated the feasibility and effectiveness of a virtual learning collaborative program to assess the improvement in implementation of a treat-to-target approach in rheumatoid arthritis.

Despite the COVID-19 pandemic, a virtual learning collaborative (LC) program may improve the implementation of a treat-to-target (TTT) approach in rheumatoid arthritis (RA), according to study results published in Arthritis Care & Research.

Researchers conducted a brief virtual LC to determine the feasibility and effectiveness of the model in improving TTT in RA.

The study included 18 arthritis practices (n=45 rheumatologists and nurse practitioners) in 10 US states and Washington, District of Columbia. The number of patients with RA being treated at each practice varied from less than 300 to more than 1500 per year. A 6-month virtual LC was tested during the COVID-19 pandemic in 2020 and 2021, during which 3 practices reported between 0% and 5% virtual visits, and 1 practice reported more than 80% virtual visits.

Videoconferencing, as well as a website for data sharing, was used during LC meetings that included 6 monthly webinars following a 6-hour introductory session. These LC sessions included discussions of the rationale and implementation of TTT in RA, reinforcement of topics, and demonstrations of data on adherence. Adherence to TTT was compared between virtual visits and in-person visits using linear mixed-effects regression analysis.

Adherence to TTT increased from 50% at baseline to 85% over a period of 6 months of LC (P <.0001), with clinical measurement and shared decision-making showing the greatest increase among LC components. Virtual visits were initially associated with a lower adherence to TTT compared with in-person visits (43% vs 67%, respectively; P ≤.0001); however, at the end of the LC, the 2 methods were more comparable (76% vs 85%, respectively; P =.55).

Study limitations included sparse literature on virtual LCs and the difficulty in measuring disease activity in a virtual format.

The researchers concluded that “short-term virtual LCs may be appropriate to pursue in rheumatology,” but that “delivering organized quality improvement efforts involving many practices is not a simple task.”

They also noted, “Possible areas for improvement might include glucocorticoid-induced osteoporosis management, vaccination practices, and cardiovascular risk factor management.”

Disclosure: This clinical trial was supported by AbbVie. Please see the original reference for a full list of authors’ disclosures.


Solomon DH, Pincus T, Shadick NA, et al. Implementing a treat-to-target approach for rheumatoid arthritis during the COVID-19 pandemic: results of a virtual learning collaborative program. Arthritis Care Res. Published online December 7, 2021. doi:10.1002/acr.24830