Affiliation:
1. Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié‐Salpêtrière Hospital Paris France
2. Laval University Québec City Québec Canada
3. Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
4. University of Milan and ASST G. Pini‐CTO Institute Milan Italy
5. Monash University, Melbourne, The Australian National University, Canberra, New South Wales, and Emeritus Research Melbourne Victoria Australia
6. University of Manchester and NIHR Manchester Biomedical Research Centre Manchester United Kingdom
Abstract
ObjectiveTreat‐to‐target is recommended in the management of rheumatoid arthritis (RA) but its implementation is suboptimal. We aimed to identify interventional strategies targeted at improving treat‐to‐target implementation in RA by systematically reviewing published evidence on barriers to, facilitators of, and interventions to support treat‐to‐target implementation.MethodsSystematic and scoping literature searches in PubMed/MEDLINE, BIOSIS Previews, Derwent Drug File, Embase, EMCare, International Pharmaceutical Abstracts, and SciSearch were conducted to identify barriers/facilitators and interventions relating to treat‐to‐target implementation in RA. The quality of included studies was assessed using Critical Appraisal Skills Programme (CASP) checklists. Data related to barriers/facilitators and interventions were extracted, grouped, and summarized descriptively, and a narrative synthesis was generated.ResultsIn total, 146 articles were analyzed, of which 123 (84%) included ≥50% of the items assessed by CASP checklists. Of the 146 studies, 76 evaluated treat‐to‐target barriers and facilitators, from which 329 relevant statements were identified and regrouped into 18 target areas, including health care professional (HCP) or patient knowledge or perceptions; patient‐HCP communication or alignment; and time or resources. Overall, 56 interventions were identified from 70 studies across the 18 target areas; 54% addressed disease activity or patient‐reported outcome assessments. Of the 56 interventions identified, 36 improved treat‐to‐target implementation and/or patient outcomes in RA.ConclusionDespite long‐established treat‐to‐target recommendations, there remain many barriers to its implementation. Interventions to improve treat‐to‐target should be developed further and assessed, with a particular focus on tailoring them to individual countries, regions, and health care settings.