Dr Helen Benham

Treat to Target in Rheumatoid Arthritis (RA TTT) is a way of treating RA where a ‘target’ is set by both the patient and the rheumatologist. This is similar to the approach taken in diabetes and hypertension where a target for treatment is established based on evidence for disease improvement. Using an RA TTT strategy has been shown to significantly improve outcomes for people living with RA. However, implementing RA TTT has many challenges and as a result, an ‘evidence-practice’ gap has emerged. This project is attempting to address this gap via analysis of patient and clinician opinion regarding knowledge, understanding of and use and acceptance of RA TTT in Australia. Additionally a tool (for use on a tablet device) has been designed and is being tested for use by both the patient and rheumatologist at the point of care to allow for an RA TTT shared decision-making process to be instigated.

The research project aimed to investigate patient perspectives and clinicians’ knowledge and acceptance of RA TTT and then address the RA TTT evidence-practice gap through the development of a patient-centred knowledge-translation (KT) tool (on a tablet device) and to determine its effectiveness in ‘real-life’ clinical settings. This is important as addressing the gap will reduce disease activity and therefore reduce pain, improve function and prevent progression of damage. TTT regimens reduce disability, increase quality of life and normalise life expectancy in RA.

We have discovered from the patient surveys that a significant number of patients feel their RA treatment could be improved (48%) and many would like to be more involved in their treatment decisions (28%). Strikingly most patients (91%) have no knowledge of RA TTT but when given education about it they report high levels of agreement and a high level of willingness to try a TTT approach for their RA. Approximately 50% of rheumatologists reported very often or often using RA TTT in daily practice with the barriers including time pressures, concerns around patient acceptance and adherence to medication changes, lack of appointment availability and the lack of a rheumatology nurses in clinics. Given the significant clinician and patient barriers identified we have used this information to further inform the development and testing of the KT tool. This tool has been designed to explain RA TTT to patients before they go in for an appointment (in the waiting room) and then for it to be used during the consultation. The usability testing before and during 40 patient-rheumatologist appointments has just been completed and the data is being analyzed at present.

This research actively continues with the analysis of the usability study and we expect the results to further improve our understanding of the patient’s perspective on RA TTT and to demonstrate that a patient-centred KT tool is acceptable, feasible and effective in real-life clinical settings. The next step is to consider a pragmatic multi-centre randomised controlled trial (RCT) comparing the effectiveness of a patient-centred RA TTT approach using the tool with existing standard care. This innovative project will be one of the first implementation projects undertaken in Australia within RA TTT and we believe that it will provide important data demonstrating the importance of translating research into practice and the value in a patient-orientated approach to care of RA. This initial funding has allowed us to establish this program of research and we are very grateful to Arthritis Australia and The Ride for Arthritis Grant in Aid funded by Chris Barrie and team.