medwireNews: A learning collaborative has improved adherence to a treat-to-target (TTT) approach for patients with rheumatoid arthritis (RA) irrespective of whether patients are seen virtually or face to face, show findings from an analysis of 18 US clinics.
The clinics, involving 45 clinicians, participated in a learning collaborative called TRACTION. The main aim of the collaborative was to improve adherence to TTT for patients with RA by providing clinicians with a 5–6-hour kick-off learning session followed by six webinars every month based on Plan-Do-Study-Act cycles.
The learning collaborative coincided with the COVID-19 pandemic and so was delivered totally virtually and during a time when there was a “30–40-fold” increase in virtual patient visits, highlighted study author Daniel Solomon (Brigham and Women's Hospital, Boston, Massachusetts, USA). This provided the opportunity to compare the effects of virtual versus in-person visits on the learning collaborative outcomes.
“While all clinicians have experience with episodic telephone visits, ongoing care using video is an area where few have extensive experience,” he noted.
The primary outcome of the study was the percentage of adherence with TTT at a given visit for RA based on the four components:
- measure and document RA disease activity;
- determine a target disease activity;
- make treatment changes if not at target; and
- document shared decision-making.
Presenting the findings in a poster and oral abstract at the ACR Convergence 2021 virtual meeting, Solomon said that during the 6 months, adherence with TTT improved significantly overall, from an average of 50% in November 2020 to about 75% in April 2021.
There was a greater adherence with TTT when visits were face-to-face rather than virtual. And all components occurred more commonly with face-to-face than virtual visits, significantly so for measuring and documenting RA disease activity (87.4 vs 67.8%) and determining a target disease activity (80.4 vs 59.9%).
However, Solomon pointed out that from December 2020 to April 2021, adherence with TTT improved similarly in both groups and by the end there was no significant difference in TTT adherence rates between the two groups, at around 85% with face-to-face visits and 76% with virtual visits.
He concluded: “A learning collaborative helped to improve adherence with treat to target during virtual visits to the point where adherence was very similar to in-person visits.”
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ACR Convergence 2021; 3–9 November (abstract 1448)
ACR Convergence 2021; 3–9 November (abstract 0815)