title: A maximum difference scaling survey of barriers to intensive combination treatment strategies with glucocorticoids in early rheumatoid arthritis.
abstract: The objectives of the study were to determine the relative importance of barriers related to the provision of intensive combination treatment strategies with glucocorticoids (ICTS-GCs) in early rheumatoid arthritis (ERA) from the rheumatologists' perspective and to explore the relation between rheumatologists' characteristics and importance scores. A maximum difference scaling (MDS) survey was administered to 66 rheumatologists in Flanders and the Brussels-Capital Region. The survey included 25 barriers, previously being discovered in a qualitative study. The survey included 25 choice sets, each of which contained a different set of four barriers. In each choice situation, respondents were asked to choose the most important barrier. The mean relative importance score (RIS) for each barrier was calculated using hierarchical Bayes modeling. The potential relation between rheumatologists' characteristics and the RIS was examined using Spearman's correlation coefficient, Mann-Whitney U test, and Kruskal-Wallis H test. The three highest ranked barriers included "contraindicated for some patients (e.g., patients with comorbidities, older patients)," "an increased risk of side effects and related complications," and "patients' resistance" with a mean ± SD RIS of 9.76 ± 0.82, 8.50 ± 1.17, and 7.45 ± 1.22, respectively. Comparing the RISs based on rheumatologists' characteristics, a different ranking was found for three barriers depending on the age, university location, and/or frequency of prescribing ICTS-GCs. The dominant barriers hindering ICTS-GCs prescription from a rheumatologists' perspective are patient-related barriers and barriers related to the complexity of prescribing a combination therapy including GCs. A tailored improvement intervention is needed to overcome these barriers and should focus on the familiarity of rheumatologists with ICTS-GC and patient education.
authors.affiliation: Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven - University of Leuven, Herestraat 49, box 7003, 3000, Leuven, Belgium, sabrina.meyfroidt@med.kuleuven.be.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Meyfroidt
authors.forename: Marlies
authors.initials: M
authors.lastname: Hulscher
authors.forename: Diederik
authors.initials: D
authors.lastname: De Cock
authors.forename: Kristien
authors.initials: K
authors.lastname: Van der Elst
authors.forename: Johan
authors.initials: J
authors.lastname: Joly
authors.forename: René
authors.initials: R
authors.lastname: Westhovens
authors.forename: Patrick
authors.initials: P
authors.lastname: Verschueren
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D001499:Bayes Theorem; D001530:Belgium; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D061345:Early Medical Intervention; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012219:Rheumatology; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids