title: Adjustment in the clinical practice of treat-to-target guidelines for rheumatoid arthritis: Results of the ToARCan study.
abstract: OBJECTIVE
  To analyze compliance with t2t clinical practice guidelines.
  
  
  METHODS
  Cross-sectional observational study in consecutive patients with rheumatoid arthritis (RA) in 5 hospitals in the Canary Islands. Patients filled out activity scales, HAQ and answered the question of whether the doctor had explained the treatment target. The rheumatologist also collected: visits in the past year, use of activity indices and HAQ, DAS28 of current visit and date of the next visit. The percentage of compliance to indicators based on the t2t recommendations (R) 1, 3, 5-7 and 10 was analyzed.
  
  
  RESULTS
  A total of 343 patients were recruited, 77% female, mean age 57, RA duration of 10 years. Median visits in the last year were 3 and mean time between last and current visit was 5.6 months. A total of 93% of the patients were treated with DMARDs and 44% were in remission by DAS (R1). In the previous visit, documented joint count was present in 85%, a HAQ in 19%, patient VAS in 41%, and a DAS28 in 35% of the patients (R6). The next visit was scheduled at an average of 4.3 months (R5). In 64% of patients with DAS28> 3.2 a visit between one and 3 months was scheduled (R5). A total of 96% of patients said they had been informed of the treatment target (R10). Variability between centers existed but was moderate. The only factor determining the performance of a DAS28 in the last visit was the patient's center of origin.
  
  
  CONCLUSIONS
  The Canary Island centers studied achieved high levels of remission and low activity in their patients. The performance of composite indices and follow-up frequency recommended by the t2t are met, although there is room for improvement.
authors: Servicio de Reumatología, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, España. Universidad de Las Palmas de Gran Canaria, Gran Canaria, España. Electronic address: anarher@gobiernodecanarias.org.
authors: Antonio
authors: A
authors: Naranjo
authors: Servicio de Reumatología, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, España. Universidad de Las Palmas de Gran Canaria, Gran Canaria, España.
authors: Laura
authors: L
authors: Cáceres
authors: Servicio de Reumatología, Complejo Hospitalario Universitario Materno Insular de Gran Canaria, Gran Canaria, España.
authors: José Ángel
authors: JÁ
authors: Hernández-Beriaín
authors: Servicio de Reumatología, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, España. Universidad de Las Palmas de Gran Canaria, Gran Canaria, España.
authors: Félix
authors: F
authors: Francisco
authors: Servicio de Reumatología, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, España. Universidad de Las Palmas de Gran Canaria, Gran Canaria, España.
authors: Soledad
authors: S
authors: Ojeda
authors: Servicio de Reumatología, Hospital Dr. Molina Orosa, Lanzarote, España.
authors: Sigrid
authors: S
authors: Talaverano
authors: Servicio de Reumatología, Complejo Hospitalario Universitario Materno Insular de Gran Canaria, Gran Canaria, España.
authors: Javier
authors: J
authors: Nóvoa-Medina
authors: Servicio de Reumatología, Hospital Dr. Molina Orosa, Lanzarote, España.
authors: José Adán
authors: JA
authors: Martín
authors: Servicio de Reumatología, Hospital Universitario de Canarias, Tenerife, España.
authors: Esmeralda
authors: E
authors: Delgado
authors: Servicio de Reumatología, Hospital Universitario de Canarias, Tenerife, España.
authors: Elisa
authors: E
authors: Trujillo
authors: Servicio de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, España.
authors: Fátima
authors: F
authors: Álvarez
authors: Servicio de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, España.
authors: Laura
authors: L
authors: Magdalena
authors: Servicio de Reumatología, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, España. Universidad de Las Palmas de Gran Canaria, Gran Canaria, España.
authors: Carlos
authors: C
authors: Rodríguez-Lozano
mesh_terms: D000328:Adult; D000359:Aftercare / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D016903:Drug Monitoring / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D013030:Spain; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: Adherence; Artritis reumatoide; Calidad asistencial; Cumplimiento; DAS28; Health care quality; Indicadores de calidad; Rheumatoid arthritis; Treat-to-target; quality indicators