Against the background of the developments in rheumatology, we have undertaken a study to develop an innovative RA medication assessment tool (RhMAT) for clinical use.
Development of the RhMAT
The RhMAT is designed in the form of a table, which allows the researcher to easily document the necessary response. The RhMAT consists of 11 separate sections, addressing:
- Diagnosis of RA;
- Use of analgesics and non-steroidal anti-inflammatory drugs;
- Use of methotrexate;
- Use of sulfasalazine;
- Use of hydroxychloroquine;
- Use of leflunomide;
- Use of sodium aurothiomalate parenteral preparation;
- General screening for biological therapies;
- Use of biological therapies;
- Use of glucocorticoids; and
- Remission cases.
Each section consists of an average of five criteria (SD=1.95). The respective references to the criteria included in the RhMAT are documented in a separate column at the far right of the table design. Each criterion is judged for applicability and adherence. If the criterion is applicable, a “yes” or “no” answer is required. If the criterion is not met, the response would be “no.” If the “no” response is justified according to a logistic reason, then it is a justified no (NoJ) and the justification is given in the comments section. NoUJ signifies that the “no” is unjustified. If criterion adherence cannot be determined, due to incomplete data that cannot be collected through a patient’s medical case notes or through a patient interview, the response to the criterion should be marked as insufficient data (ID). Guidelines incorporated within the RhMAT were compiled to explain the procedure to complete the table and allow standardization and uniformity in the practical scenario.
The RhMAT was developed using evidence-based RA guidelines, recommendations and standards from the ACR, EULAR, the British Society for Rheumatology, the National Institute for Health and Care Excellence, and the Scottish Intercollegiate Guidelines Network. The Summary of Product Characteristics for each drug included in the RhMAT were used as references for criteria related to pharmacological properties. The developed RhMAT was subjected to a focus group review that assessed applicability of the tool to the practical scenario, presentation, robustness and validity of the data provided.
The RhMAT incorporates a mathematical equation that yields the adherence rate to the criteria included in the tool. The adherence rate to the RhMAT is calculated as the sum of the “yes” responses expressed as a percentage of the total number of applicable cases, whereby the applicable cases constitute the number of “yes” responses, the NoUJ responses and the ID responses. The overall RhMAT incorporating all 11 sections can be calculated, as can the adherence rate to each of the separate applicable sections, depending on the drugs prescribed for individual patients. Thus, if a patient is receiving methotrexate and sulfasalazine, the pharmacist can calculate the overall RhMAT adherence rate in addition to the adherence rate for methotrexate and sulfasalazine separately.
