Implementation of Treat-to-Target for Rheumatoid Arthritis in the US: Analysis of Baseline Data From a Randomized...

Area of Science:

• Rheumatology
• Clinical Practice Research
• Health Services Research

Background:

• The treat-to-target (TTT) strategy is a recommended approach for managing rheumatoid arthritis (RA).
• Understanding provider adherence to TTT in real-world clinical practice is crucial for optimizing RA patient outcomes.
• Current adherence levels to TTT guidelines among US rheumatologists are not well-established.

Purpose of the Study:

• To examine the adherence of healthcare providers to the treat-to-target (TTT) strategy in rheumatoid arthritis (RA) clinical practice.
• To assess the implementation of key TTT components across different US rheumatology sites and providers.

Main Methods:

• Utilized baseline data from the "Treat-to-Target in RA: Collaboration to Improve Adoption and Adherence" trial.
• Included 641 patients and 46 providers from 11 US rheumatology sites.
• Assessed TTT implementation using four cardinal features: disease target recording, disease activity measurement, shared decision-making, and treatment adjustment; calculated a TTT implementation score.

Main Results:

• Baseline TTT implementation was suboptimal, with 64.3% of visits lacking any TTT components and only 0.3% including all components.
• Significant differences in TTT implementation were observed across providers and sites (P < 0.0001).
• Greater rheumatologist experience was associated with higher TTT implementation scores; providers with >20 years of experience showed significantly higher odds of recording more TTT components (OR 7.68).

Conclusions:

• Adherence to the treat-to-target (TTT) strategy in rheumatoid arthritis (RA) is suboptimal in US clinical practice.
• Significant variability exists in TTT implementation across different providers and rheumatology sites.
• Provider experience appears to be a factor influencing the adoption of TTT components.