类风湿关节炎实施 "治疗到目标 "的障碍、促进因素和干预措施:系统综述。

IF 3.7 2区 医学 Q1 RHEUMATOLOGY Arthritis Care & Research Pub Date : 2024-08-01 DOI:10.1002/acr.25408
Laure Gossec, Louis Bessette, Ricardo M Xavier, Ennio G Favalli, Andrew Östör, Maya H Buch
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引用次数: 0

摘要

目的:在类风湿性关节炎(RA)的治疗过程中,推荐采用 "靶向治疗"(T2T),但其实施效果并不理想。我们旨在通过系统回顾已发表的有关T2T实施障碍、T2T实施促进因素和T2T实施干预措施的证据,确定旨在改善类风湿关节炎T2T实施的干预策略:在PubMed/MEDLINE®、BIOSIS Previews®、Derwent Drug File、Embase®、EMCare®、International Pharmaceutical Abstracts和SciSearch®中进行了系统性和范围性文献检索,以确定与RA实施T2T相关的障碍/促进因素和干预措施。采用批判性评估技能计划(CASP)核对表对纳入研究的质量进行评估。对与障碍/促进因素和干预措施相关的数据进行了提取、分组和描述性总结,并形成了叙述性综述:共分析了 146 篇文章,其中 123 篇(84%)包含≥50%的 CASP 检查单评估项目。在这 146 篇研究中,有 76 篇对 T2T 的障碍和促进因素进行了评估,从中确定了 329 项相关陈述,并将其重新归纳为 18 个目标领域,包括:医护人员或患者的知识或认知;患者与医护人员的沟通或协调;时间或资源。总体而言,从 70 项研究中确定了 56 项干预措施,涉及 18 个目标领域;其中 54% 涉及疾病活动或患者报告的结果评估。在确定的56项干预措施中,36项改善了T2T的实施和/或RA患者的预后:结论:尽管 T2T 建议早已确立,但其实施仍存在许多障碍。应进一步制定和评估改善T2T的干预措施,尤其要注重根据各个国家、地区和医疗机构的具体情况进行调整。
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Barriers to, Facilitators of, and Interventions to Support Treat-to-Target Implementation in Rheumatoid Arthritis: A Systematic Review.

Objective: Treat-to-target (T2T) is recommended in the management of rheumatoid arthritis (RA) but its implementation is suboptimal. We aimed to identify interventional strategies targeted at improving T2T implementation in RA by systematically reviewing published evidence on barriers to, facilitators of, and interventions to support T2T implementation.

Methods: Systematic 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 T2T 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.

Results: In total, 146 articles were analyzed, of which 123 (84%) included ≥50% of the items assessed by CASP checklists. Of the 146 studies, 76 evaluated T2T barriers and facilitators, from which 329 relevant statements were identified and regrouped into 18 target areas, including: healthcare professionals' (HCPs') or patients' 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 T2T implementation and/or patient outcomes in RA.

Conclusion: Despite long-established T2T recommendations, there remain many barriers to its implementation. Interventions to improve T2T should be developed further and assessed, with a particular focus on tailoring them to individual countries, regions, and healthcare settings.

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来源期刊
CiteScore
9.40
自引率
6.40%
发文量
368
审稿时长
3-6 weeks
期刊介绍: Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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